UNUM Evidence of Insurability Submission Forms
This is the UnumProvident Evidence of Insurability form. If you are required to submit Evidence of Insurability for your coverage, please [click here] to complete the form and submit electronically. To complete this process you will need:
Policy number: 501067
- Company name and address
- Names and birthdays of all applicants requiring Evidence of Insurability
- Names and addresses of physicians consulted by applicants requiring Evidence of Insurability
- Coverage types and amounts.
- Non-medical maximum coverage amount (See your Benefits Administrator)”
This Web-based form is for use by applicants eligible for coverage under contracts underwritten by Unum Life Insurance Company of America or First Unum Life Insurance Company.
Note: Currently this process only supports U.S. residents.
If at any time you have technical questions, please contact the Internet Service Center by e-mailing iServices@unumprovident.com or call 1-877-225-2712.
