Disability Insurance

Disability Insurance Forms

Title What is This For? Contact Information
Employer Initial Enrollment Form - Employer-Paid Plans Initial application form for employers to enroll in a non-contributory (employer-paid) disability plan

Church Pension Group
19 East 34th Street
New York, NY 10016
Attn: Angelica Merola

Employer Initial Enrollment Form - Voluntary Plans Initial application form for employers to enroll in a voluntary (employee-paid) disability plan

Church Pension Group
19 East 34th Street
New York, NY 10016
Attn: Angelica Merola

Enrollment Data Collection Form To enroll, change, or terminate employees in Group Term Life and Disability Insurance plans.

Please fax the completed form to: (212) 251-8969
or mail to: The Church Pension Fund, 19 East 34th Street, New York, NY 10016, Attn: Policy Service

Liberty Mutual Evidence of Insurability Form for Disability Coverage Form to complete when applying for disability insurance

Liberty Life Assurance Company of Boston
Attn: Group Underwriting Department
P.O. Box 1525
Dover, NH 03821-1525

 

 

* Our online documents are available for immediate download and viewing using Adobe's FREE Acrobat Reader.