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W-9

Personal Financial Statement

Health Insurance Portability and Accountability Act of 1996 

Authorization Form 9332 (HIPAA)

(For CO, FL, IA, KA, KY, MA, MS, MO, NH, NM, NC, PA, TN, TX, UT, and WV)

Health Insurance Portability and Accountability Act of 1996 

Authorization Form 4147 (HIPAA)

(For CA ONLY)

Health Insurance Portability and Accountability Act of 1996 

Authorization Form 9245 (HIPAA)

(For all other States)

A.L.P.S.™ Documentation Explanation Page

A.L.P.S.™ Documentation Checklist

Confidentiality Agreement

Authorization for the Release of Underwriting Information

rev 07/13/2004

2nd to Die - Survivorship UL

ANICO Survivorship Agreement 

rev 06/05/2001

ANICO Survivorship A & W 

rev 06/05/2001

ANICO Survivorship General Assignment 

rev 06/05/2001

ANICO Survivorship Endorsement 

(Michigan, Oregon, Pennsylvania, Maryland and New Mexico Only)

rev 03/06/2003

ANICO Survivorship Endorsement 

(All Other States)

rev 06/18/2002

Individual - Passport UL

ANICO Individual Agreement 

rev 06/05/2001

ANICO Individual A & W 

rev 06/05/2001

ANICO Individual General Assignment 

rev 06/05/2001

ANICO Individual Endorsement 

(Michigan, Oregon, Pennsylvania, Maryland and New Mexico Only)

rev 03/06/2003

ANICO Individual Endorsement 

(All Other States)

rev 06/18/2002

ANICO Preferred Questionnaire

Please contact STP for HIV, Fraud and Replacement forms

Collateral Documents

BOA CD Opener 

Corporation Collateral Documents

Limited Liability Corporation Resolution

Sole Proprietorship Resolution 

Partnership Resolution 

Corporate Resolution 

For Collateral Document Questions please E-mail Adam Simon

(Requires Adobe Acrobat Reader)

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Last modified: July 13, 2004