Application Forms - Please use the drop down box to go to the appropriate state and download Application Forms specific to your state. Application forms must be signed by the customer.

Outline Of Coverage (required in some states) - Some States also require an Outline of Coverage to be submitted with the Application Form and both documents must be executed by your client at time of solicitation. Please use the drop down box to go to the appropriate state to see if an Outline of Coverage is required and download it if needed.

Client Authorization Form - Authorization forms must be signed by your customer. It is included in the Fidelity Security Application and is required for us to review the client’s medical records. You may however have the customer sign this standalone Authorization form if you suspect that he or she might be declined by a standard carrier in order to facilitate the transfer of the case to Risk Insurance/ Fidelity Security.