5381dc 2026

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The document is an Occupational Duties Questionnaire application supplement for Individual Disability Insurance from Standard Insurance Company. It requires the proposed insured to detail their primary occupational duties, including frequency and time spent on tasks, and whether any duties are performed at home. The applicant must affirm the truthfulness of their responses and acknowledges the legal implications of providing false information.

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Click ‘Get Form’ to open the 5381dc in the editor.
Begin by entering your personal information in the 'Proposed Insured' section, including your name and birth date.
In section 1a, list and describe your occupational duties. Check whether these tasks are performed daily or weekly, and provide a percentage of time spent on each task. Ensure that the total adds up to 100%.
For section 1b, detail any additional occupational duties performed less frequently. Specify how often these tasks are done and the time spent on each.
Answer question 2 regarding whether you perform any duties at home by selecting 'Yes' or 'No', and if applicable, indicate the percentage of time spent on those duties.
Use the remarks section to add any additional information relevant to your application.
Finally, review all entries for accuracy before signing and dating the form at the bottom.

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Versions	Form popularity	Fillable & printable
2017	4.8 Satisfied (104 Votes)

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