Section 1 should always be completed by the named beneficiary on the policy.
Section 2 should be completed by the named beneficiary if the policy has been in force for less than two years.
Section 3 should be completed by a physician if the life policy has been in force for less than two years.
Section 4 should be completed by the named beneficiary if the loss was due to an accident.
Section 5 should be completed by a physician if the loss was due to an accident.
Finally, you must fill out and sign the HIPPA authorization found at the end of the form.