Filing Information Form Deviations # Deviation Content 1 2 3 4 5 6 15 7 8 9 10 11 12 Other Form Information Does this group use the issuer’s standard application? Yes. (The issuer will be using the application form filed with the Standard Master.) 16 No. (The custom application form must be submitted for review on the Form Schedule Tab.) Does this use the issuer’s standard enrollment form? Yes. (The issuer will be using the enrollment form filed with the Standard Master.) 17 No. (The custom enrollment form must be submitted for review on the Form Schedule Tab.) Public Rate Schedule
Filing Information Form Deviations 15 # Deviation Content 1 2 3 4 5 6 7 8 9 10 11 12 Other Form Information 16 Does this group use the issuer’s standard application? Yes. (The issuer will be using the application form filed with the Standard Master.) No. (The custom application form must be submitted for review on the Form Schedule Tab.) 17 Does this use the issuer’s standard enrollment form? Yes. (The issuer will be using the enrollment form filed with the Standard Master.) No. (The custom enrollment form must be submitted for review on the Form Schedule Tab.) Public Rate Schedule
short-form-filing-summary-edition5.docx