Forms All forms are in Adobe® Acrobat® format. Click on the form you need and you should see the form appear in a new window. Print, complete and sign the form before submitting it to your employer or Boston Mutual Life Insurance Company.

PORTABILITY: Portability enables the insured employee to continue all of their Group Term Basic Life Insurance* and/or Voluntary Life Insurance, including any Voluntary Life Insurance in effect on the spouse and children, upon leaving employment. Portable Life Insurance is Group Term Life Insurance that does NOT include Waiver of Premium or Accidental Death and Dismemberment coverage. If you are interested in purchasing Portable Life Insurance, please complete and return the attached notice to: Group Billing Department Boston Mutual Life Insurance Company 120 Royall Street Canton, MA 02021-1098

Note: Because employees have only 31 days from the date employment ends, it is extremely important that the Employer provide them with this form on or before the date of termination. The portability feature is not available if the coverage terminated due to cancellation of the Group Policy.

*Group Term Renewable Product (GRTP) only- see master policy.