The Life Underwriting Guide - Pilot Insurance Center

REPLACEMENT FORMS (Alabama to Montana)
The E-Replacement Questionnaire (EREPL) is required in all states except New York.
The NAIC E-Replacement Disclosure Notice (EREPLDIS-NAIC) is required in the NAIC states only
(shown in Navy Blue).
The E-Replacement Sales Material Disclosure Form (EREPLSMDIS) is required in the NAIC states.
The E-Replacement Disclosure Notice (EREPLDIS-XX, state-specific or generic) is required in
all non-NAIC states, and the few states (shown in Brown) where no state form is required.
STATE EREPL EREPLDIS-NAIC EREPLSMDIS EREPLDIS-XX
Alabama Required Required Required
Alaska Required Required Required
Arizona Required Required Required
Arkansas Required EREPLDIS-AR
California Required EREPLDIS-CA-A
EREPLDIS-CA-B
Colorado Required Required Required
Connecticut Required EREPLDIS
D.C. Required EREPLDIS
Delaware Required EREPLDIS-DE
Florida Required EREPLDIS-FL-A
Georgia Required EREPLDIS-GA
Hawaii Required Required Required
Idaho Required EREPLDIS-ID
Illinois Required EREPLDIS-IL
Indiana Required EREPLDIS-IN
Iowa Required Required Required
EREPLDIS-KS-A
Kansas
Required
EREPLDIS-KS-B
EREPLDIS-KS-C
Kentucky Required Required Required
Louisiana Required Required Required
Maine Required Required Required
Maryland Required Required Required
Massachusetts Required EREPLDIS-MA
Michigan Required EREPLDIS-MI
Minnesota Required EREPLDIS-MN
Mississippi Required Required Required
Missouri Required EREPLDIS-MO
Montana Required Required Required
FOR FINANCIAL PROFESSIONAL USE ONLY --- NOT FOR PUBLIC DISTRIBUTION
29