Forms

To fill out an online form, please choose from the menu below:

After completion, sign and date the form on the last page where indicated. Copy for your records and return to the Plan Administrator:
SelmanCo, Attention: Enrollment Department
1 Integrity Parkway
Cleveland, OH 44143-1500

Phone: 800-928-6421
Fax 502-425-3127
Email: memerservices@selmanco.com

Please include the following forms with your application:

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Life Insurance Applications (KY, IN, & OH Residents)

Life Insurance Enrollment Form - Kentucky Attorney - (For KY, IN, and OH Residients Only)

Life Insurance Enrollment Form - Kentucky Society of Certified Public Accountants - (For KY, IN, and OH Residents Only)

Life Insurance Enrollment Form - Kentucky Dentist - (For KY, IN, and OH Residents Only)

Life Insurance Enrollment Form - Kentucky Physician - (For KY, IN, and OH Residents Only)

Disability Insurance Applications (KY Residents Only)

Disability & Business Overhead Expense Insurance Enrollment Form - Kentucky Bar Association - (For KY Residents Only)

Disability & Business Overhead Expense Insurance Enrollment Form - Kentucky Society of Certified Pulic Accountants - (For KY Residents Only)

Disability & Business Overhead Expense Insurance Enrollment Form - Kentucky Dentist - (For KY Residents Only)

Disability & Business Overhead Expense Insurance Enrollment Form - Kentucky Physician - (For KY Residents Only)

Disability Insurance Applications (IN Residents Only)

Disability & Buisiness Overhead Expense Insurance Enrollment Form - Kentucky Bar Association - (For IN Residents Only)

Disability & Buisiness Overhead Expense Insurance Enrollment Form - Kentucky Society of Certified Public Accounts - (For IN Residents Only)

Disability & Business Overhead Expense Insurance Enrollment Form - Kentucky Dentist - (For IN Residents Only)

Disability & Business Overhead Expense Insurance Enrollment Form - Kentucky Physician - (For IN Residents Only)

Disability Insurance Applications (OH Residents Only)

Disability & Business Overhead Expense Insurance Enrollment Form - Kentucky Bar Association - (For OH Residents Only)

Disability & Buisiness Overhead Expense Insurance Enrollment Form - Kentucky Society of Certified Public Accounts - (For OH Residents Only)

Disability & Business Overhead Expense Insurance Enrollment Form - Kentucky Dentists - (For OH Residents Only)

Disability & Business Overhead Expense Insurance Enrollment Form - Kentucky Physician - (For OH Residents Only)

Other Forms

Metlife Absolute Assignment Form

Metlife Beneficiary Change Form

Metlife Collateral Assignment Form