2007-2008 IEEE Multiplan Brochure - (Page 68) life insurance policy or annuity contract, and may have the right to reinstate or restore any life insurance policies and annuity contracts that were surrendered, lapsed or changed in the transaction to their former status to the extent possible and in accordance with the insurer’s published reinstatement rules to the extent such rules are not inconsistent with the provisions of this part. IMPORTANT: THIS RIGHT SHOULD NOT BE VIEWED AS REINSTATING OR RESTORING YOUR LIFE INSURANCE POLICY OR ANNUITY CONTRACT TO THE SAME CONDITION AS IF IT HAD NEVER BEEN REPLACED. THERE MAY BE CONSEQUENCES IN REINSTATING OR RESTORING YOUR LIFE INSURANCE POLICY OR ANNUITY CONTRACT, INCLUDING BUT NOT LIMITED TO: The right to reinstate or restore your life insurance policy or annuity contract applies only to companies subject to New York insurance laws; Your life insurance policy or annuity contract is subject to your specific company’s reinstatement rules, which may vary from company to company. These rules may require payment of both premium and interest; however, you will not be subject to evidence of insurability, or a new contestable or suicide period; You may not receive the interest or investment performance during the period the life insurance policy or annuity contract was replaced; and There may be unfavorable federal income tax consequences as a result of the reinstatement of your life insurance policy or annuity contract. IMPORTANT: In the case of a variable or market value adjustment policy or contract, the value of the policy or contract may increase or decrease during the 60-day period depending on the performance of the underlying investments, which may affect the value of the refund you receive. Please provide the information requested below for each existing policy or contract you are replacing. (Attach a separate sheet if necessary.) Sign and date the completed form and mail it back with your completed Application. INSURER NAME CONTRACT OR POLICY # INSURED OR ANNUITANT REPLACED (R) OR FINANCING (F) REASON FOR REPLACEMENT 1. 2. 3. 4. 5. I hereby acknowledge that I read the above “IMPORTANT NOTICE.” Date: Signature of member applicant: [Mr. Sample Sample] Date: Signature of joint applicant: [Mrs. Sample Sample] SM-NY60-IN-ND GMAD 10/2006 Office Use Only: Date Control # SS#
Table of Contents Feed for the Digital Edition of 2007-2008 IEEE Multiplan Brochure Group Term Life Insurance Plan Group 10-Year Level Term Life Insurance Plan Group 20-Year Term Life Insurance Plan Group Disability Income Insurance Plan Professional Liability Insurance Plan Long-Term Care Plan Additional Plans & Information 2007-2008 IEEE Multiplan Brochure 2007-2008 IEEE Multiplan Brochure - (Page 1) 2007-2008 IEEE Multiplan Brochure - (Page 2) 2007-2008 IEEE Multiplan Brochure - (Page 3) 2007-2008 IEEE Multiplan Brochure - (Page 4) 2007-2008 IEEE Multiplan Brochure - Group Term Life Insurance Plan (Page 5) 2007-2008 IEEE Multiplan Brochure - Group Term Life Insurance Plan (Page 6) 2007-2008 IEEE Multiplan Brochure - Group Term Life Insurance Plan (Page 7) 2007-2008 IEEE Multiplan Brochure - Group Term Life Insurance Plan (Page 8) 2007-2008 IEEE Multiplan Brochure - Group Term Life Insurance Plan (Page 9) 2007-2008 IEEE Multiplan Brochure - Group Term Life Insurance Plan (Page 10) 2007-2008 IEEE Multiplan Brochure - Group Term Life Insurance Plan (Page 11) 2007-2008 IEEE Multiplan Brochure - Group Term Life Insurance Plan (Page 12) 2007-2008 IEEE Multiplan Brochure - Group Term Life Insurance Plan (Page 13) 2007-2008 IEEE Multiplan Brochure - Group Term Life Insurance Plan (Page 14) 2007-2008 IEEE Multiplan Brochure - Group 10-Year Level Term Life Insurance Plan (Page 15) 2007-2008 IEEE Multiplan Brochure - Group 10-Year Level Term Life Insurance Plan (Page 16) 2007-2008 IEEE Multiplan Brochure - Group 10-Year Level Term Life Insurance Plan (Page 17) 2007-2008 IEEE Multiplan Brochure - Group 10-Year Level Term Life Insurance Plan (Page 18) 2007-2008 IEEE Multiplan Brochure - Group 10-Year Level Term Life Insurance Plan (Page 19) 2007-2008 IEEE Multiplan Brochure - Group 10-Year Level Term Life Insurance Plan (Page 20) 2007-2008 IEEE Multiplan Brochure - Group 10-Year Level Term Life Insurance Plan (Page 21) 2007-2008 IEEE Multiplan Brochure - Group 10-Year Level Term Life Insurance Plan (Page 22) 2007-2008 IEEE Multiplan Brochure - Group 10-Year Level Term Life Insurance Plan (Page 23) 2007-2008 IEEE Multiplan Brochure - Group 10-Year Level Term Life Insurance Plan (Page 24) 2007-2008 IEEE Multiplan Brochure - Group 20-Year Term Life Insurance Plan (Page 25) 2007-2008 IEEE Multiplan Brochure - Group 20-Year Term Life Insurance Plan (Page 26) 2007-2008 IEEE Multiplan Brochure - Group 20-Year Term Life Insurance Plan (Page 27) 2007-2008 IEEE Multiplan Brochure - Group 20-Year Term Life Insurance Plan (Page 28) 2007-2008 IEEE Multiplan Brochure - Group 20-Year Term Life Insurance Plan (Page 29) 2007-2008 IEEE Multiplan Brochure - Group 20-Year Term Life Insurance Plan (Page 30) 2007-2008 IEEE Multiplan Brochure - Group 20-Year Term Life Insurance Plan (Page 31) 2007-2008 IEEE Multiplan Brochure - Group 20-Year Term Life Insurance Plan (Page 32) 2007-2008 IEEE Multiplan Brochure - Group 20-Year Term Life Insurance Plan (Page 33) 2007-2008 IEEE Multiplan Brochure - Group 20-Year Term Life Insurance Plan (Page 34) 2007-2008 IEEE Multiplan Brochure - Group Disability Income Insurance Plan (Page 35) 2007-2008 IEEE Multiplan Brochure - Group Disability Income Insurance Plan (Page 36) 2007-2008 IEEE Multiplan Brochure - Group Disability Income Insurance Plan (Page 37) 2007-2008 IEEE Multiplan Brochure - Group Disability Income Insurance Plan (Page 38) 2007-2008 IEEE Multiplan Brochure - Group Disability Income Insurance Plan (Page 39) 2007-2008 IEEE Multiplan Brochure - Group Disability Income Insurance Plan (Page 40) 2007-2008 IEEE Multiplan Brochure - Group Disability Income Insurance Plan (Page 41) 2007-2008 IEEE Multiplan Brochure - Group Disability Income Insurance Plan (Page 42) 2007-2008 IEEE Multiplan Brochure - Group Disability Income Insurance Plan (Page 43) 2007-2008 IEEE Multiplan Brochure - Group Disability Income Insurance Plan (Page 44) 2007-2008 IEEE Multiplan Brochure - Professional Liability Insurance Plan (Page 45) 2007-2008 IEEE Multiplan Brochure - Professional Liability Insurance Plan (Page 46) 2007-2008 IEEE Multiplan Brochure - Professional Liability Insurance Plan (Page 47) 2007-2008 IEEE Multiplan Brochure - Professional Liability Insurance Plan (Page 48) 2007-2008 IEEE Multiplan Brochure - Professional Liability Insurance Plan (Page 49) 2007-2008 IEEE Multiplan Brochure - Professional Liability Insurance Plan (Page 50) 2007-2008 IEEE Multiplan Brochure - Professional Liability Insurance Plan (Page 51) 2007-2008 IEEE Multiplan Brochure - Professional Liability Insurance Plan (Page 52) 2007-2008 IEEE Multiplan Brochure - Professional Liability Insurance Plan (Page 53) 2007-2008 IEEE Multiplan Brochure - Professional Liability Insurance Plan (Page 54) 2007-2008 IEEE Multiplan Brochure - Long-Term Care Plan (Page 55) 2007-2008 IEEE Multiplan Brochure - Long-Term Care Plan (Page 56) 2007-2008 IEEE Multiplan Brochure - Long-Term Care Plan (Page 57) 2007-2008 IEEE Multiplan Brochure - Long-Term Care Plan (Page 58) 2007-2008 IEEE Multiplan Brochure - Additional Plans & Information (Page 59) 2007-2008 IEEE Multiplan Brochure - Additional Plans & Information (Page 60) 2007-2008 IEEE Multiplan Brochure - Additional Plans & Information (Page 61) 2007-2008 IEEE Multiplan Brochure - Additional Plans & Information (Page 62) 2007-2008 IEEE Multiplan Brochure - Additional Plans & Information (Page 63) 2007-2008 IEEE Multiplan Brochure - Additional Plans & Information (Page 64) 2007-2008 IEEE Multiplan Brochure - Additional Plans & Information (Page 65) 2007-2008 IEEE Multiplan Brochure - Additional Plans & Information (Page 66) 2007-2008 IEEE Multiplan Brochure - Additional Plans & Information (Page 67) 2007-2008 IEEE Multiplan Brochure - Additional Plans & Information (Page 68) 2007-2008 IEEE Multiplan Brochure - Additional Plans & Information (Page 69) 2007-2008 IEEE Multiplan Brochure - Additional Plans & Information (Page 70)
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