Impactmobile 2026

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4.8 out of 5

156 votes

The document is a Lay-Off Waiver of Premium Claim Form from American Income Life Insurance Company, which allows insured individuals who have been laid off after 12 months of employment in the same industry to apply for a waiver of insurance premiums while they seek new work. The waiver applies to layoffs due to economic reasons affecting at least 10 people and provides benefits for up to three months if the application is submitted within 60 days of the layoff.

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Click ‘Get Form’ to open the impactmobile in the editor.
Begin by entering your personal information in the 'Insured' section. Fill in your name, policy number, address, phone number, and occupation.
Next, provide details about your employer. Include the employer's name, union and local number, and their contact phone number.
Indicate the date you quit work due to lay-off and whether you are currently employed by selecting 'Yes' or 'No'. If applicable, enter the date you returned to work.
Ensure that you sign and date the form in the designated area for the insured person.
The final step requires certification from your employer or union representative. They must fill out their section, including their signature and title.

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Versions	Form popularity	Fillable & printable
2006	4.8 Satisfied (156 Votes)

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