Prudential proof of good health 2025

1. Click ‘Get Form’ to open the Prudential Proof of Good Health in the editor.
2. Begin by filling out the Employee/Member Information section. Enter your first name, middle initial, last name, address, social security number, employee/member ID number, telephone number, and email address.
3. Next, provide Applicant Information. Indicate your relationship to the employee/member and fill in the applicant's details including first name, middle initial, last name, and social security number.
4. Select the coverage requiring Evidence of Insurability by checking the appropriate box for yourself or your spouse. Fill in gender, weight, height (in feet and inches), and date of birth.
5. Answer all health-related questions by checking 'Yes' or 'No'. Ensure accuracy as this information is crucial for underwriting.
6. Review the Important Notice section carefully before signing. Confirm that you understand the terms and conditions outlined.
7. Finally, sign and date the form at the bottom. If applicable, a parent or guardian must also sign for minors.

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