To fill out an online form, please choose from the menu below:
Once complete, you may return via email (wrl@niai.com), fax (502-425-3127) or mail to the following:
National Insurance Agency, Inc.
PO Box 306
Simpsonville, KY 40067
Metlife Absolute Assignment Form
Metlife Beneficiary Change Form
Metlife Collateral Assignment Form
Life Insurance Application for Kentucky Attorneys
Life Insurance Application for Kentucky CPAs
Life Insurance Application for Kentucky Dentists
Life Insurance Application for Kentucky Physicians
Disability Insurance Application for Kentucky Attorneys (KY residents only)
Disability Insurance Application for Kentucky CPAs (KY residents only)
Disability Insurance Application for Kentucky Dentists (KY residents only)
Disability Insurance Application for Kentucky Physicians (KY residents only)
Disability Insurance Application for Kentucky Attorneys (IN residents only)
Disability Insurance Application for Kentucky CPAs (IN residents only)
Disability Insurance Application for Kentucky Dentists (IN residents only)
Disability Insurance Application for Kentucky Physicians (IN residents only)
Disability Insurance Application for Kentucky Attorneys (OH residents only)
Disability Insurance Application for Kentucky CPAs (OH residents only)
Disability Insurance Application for Kentucky Dentists (OH residents only)
Disability Insurance Application for Kentucky Physicians (OH residents only)