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Forms and Tools to Manage Your Account

Welcome to the downloadable forms resource page. Below you will find all of the necessary forms and applications you need to process a claim or apply for additional coverages.

Downloads

Welcome to the downloadable forms resource page. Files are available in PDF format to be downloaded, printed and mailed accordingly. Acrobat Reader is a free application that can be downloaded at adobe.com/reader/.

Mail all claim forms to the following address:
AGIA Affiliate Services
Claims Department
P.O. Box 9060
Phoenix, AZ 85068

Form Product Form Type Download
Group Business Overhead Expense Editable Application Group Business Overhead Expense Enrollment Application Download
Group Business Overhead Expense Printable Application Group Business Overhead Expense Enrollment Application Download
Group Long Term Disability Income Insurance Editable Application Group Long-Term Disability Income Insurance Enrollment Application Download
Group Long Term Disability Income Insurance Printable Application Group Long-Term Disability Income Insurance Enrollment Application Download
Group Short Term Disability Income Insurance Editable Application Group Short-Term Disability Income Insurance Enrollment Application Download
Group Short Term Disability Income Insurance Printable Application Group Short-Term Disability Income Insurance Enrollment Application Download
Group Term Life Editable Application Group Term Life Enrollment Application Download
Group Term Life Printable Application Group Term Life Enrollment Application Download
SecureStart Plan Printable Application SecureStart Plan Enrollment Application Download