Forms may be downloaded by using Adobe Acrobat software. Forms should be completed and then mailed to Prudential's Group Insurance at the address indicated on each form. Obtain the plug-in and instructions for installation free of charge. Get Adobe Acrobat Reader.

General-Beneficiary
Beneficiary Statement-all other employer contracts 
Beneficiary Statement-Kentucky employer contracts only 
Beneficiary Statement-Arkansas, North Dakota employer contracts only 
Beneficiary Statement-New York  
Beneficiary Statement-Kansas, Alaska employer contracts only 
Beneficiary Statement-Minnesota, employer contracts only 
Beneficiary Designation-For All Products 
Beneficiary Designation (French)-for all products 
Beneficiary Designation (Spanish)-for all products 
Preferential Beneficiary Statement

NY disability contract cases only
Survivor Benefit Election Form 

General-Dependents Coverage
Statement of Dependent Eligibility-Limiting Age 19
Statement of Dependent Eligibility-Limiting Age 26

General-Conversion
Generic Conversion
Request for Electronic Funds Transfer

Critical Illness Insurance Claims
Critical Illness Insurance Claim Form
Critical Illness Insurance Electronic Funds Transfer Authorization

Disability and Absence Claims
Short Term Disability and Long Term Disability Claimant Statement
Social Security Authorization
Attending Physician's Statement
Attending Physician's Statement (Spanish) 
Medical Authorization
Address Verification
Tax Notice
EFT Authorization
Psychotherapy Medical Authorization
FMLA Medical Certification-Care of Family Member
FMLA Medical Certification-Own Serious Health Condition
Disability and FMLA Physician Statement-Own Serious Health Condition
FMLA Medical Certification-Request for Military Exigency Leave
FMLA Medical Certification-Request for Care of Covered Service Member
FMLA Employee Rights and Responsibilities Under the Family and Medical Leave Act

General-Life Claims
Group Life Claim Form for Total Disability Benefits - Attending Physician's Statement (Waiver of Premium)
Claimant's Statement /Attending Physician Statement
Gift Assignment to Individual
Gift Assignment to Trustee
Gift Assignment for Value
Accelerated Benefit Option Claim Form 6 month life exp
Accelerated Benefit Option Claim Form 12 month life exp
Accelerated Benefit Option Claim Form 24 month life exp
Accelerated Benefit Option Claim Form (NY)-Employee or Dependent (6)
Accelerated Benefit Option Claim Form (NY)-Employee or Dependent (12)
Group Life Claim Form for Total Disability Benefits - Employee Statement (Waiver of Premium)
HIPAA Privacy Authorization Form

General-Dental Claims
Dental Claim Form

Group Universal Life (GUL)
Paid-up Insurance Surrender Request
Loan Request
Withdrawal Request
Request to End Coverage
Lump Sum Contribution
Lump Sum Payment or Loan Repayment

Group Variable Universal Life (GVUL)
Paid-up Life Insurance or Surrender Request
Partial Withdrawal Request
Loan Request
Lump Sum Payment or Loan Repayment
Change Allocation Request
Dollar Cost Averaging Election
Dollar Cost Averaging Cancellation
Transfer Request
Request to End Coverage
GUL/GVUL Change of Name and Address Request
GUL/GVUL Gift Assignment to Individual
GUL/GVUL Gift Assignment to Trustee