Neptune-Administered Forms for Maryland

The below forms are specific to this state. Non-state specific forms can be located on the General Forms page.

Administration Back To Top

.  06670220-1183USLMD Master Application MD

Claims Back To Top

There are no state-specific forms. Use forms located on the General Forms page.

Group Statement of Insurability Back To Top

The United States Life Insurance Company

.00305101-1013USLMD Statement of Insurability for Group Programs MD

American General Life Insurance Company of Delaware

.06673571-1005USLMD Statement of Insurability for Group Programs MD

Voluntary Statement of Insurability Back To Top

American General Life Insurance Company of Delaware

.06673571-1098USLMD Application for Group Voluntary Programs All Coverages MD
.06673571-1496USLMD Application for Group Voluntary Programs Life & AD&D Only MD