New york life form for waiver of premium claim 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin with the 'Insured Information' section. Fill in your name, group number, address, social security number, date of birth, and telephone number.
3. In the 'Disability Information' section, specify the nature of your disability. Provide details on when symptoms first appeared or describe the accident if applicable.
4. Indicate the dates you claim total disability began and whether you expect to return to work. Answer questions regarding Social Security Disability benefits and any other disability benefits applied for.
5. Sign and date the 'Insured Signature' section after reading the fraud statement relevant to your state.
6. Complete the 'Medical Information and Authorization' by listing all physicians and hospitals that treated you in the last ten years.
7. Finally, ensure that your attending physician completes their section accurately before submitting the form as directed.

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