HomeMy WebLinkAboutContract No. 2015-26252015 -2625
ING a Qffi%"�W
REQUEST FOR AMENDMENT
RELIASTAR LIFE INSURANCE COMPANY
A Member of the ING Family of Companies
Administrative Office: P.O. Box 20, Minneapolis, MN 55440
Please confirm the following information:
Group Name: Anoka County Instrumentalities
Group Number: 31188 -0
Effective Date of Amendment: June 1, 2012
Amendment:
• Add a 12 month non - medical continuation provision.
Applies to the following product(s) /coverage(s):
Basic Life Suppl Life Suppl Dep AD &D
Basic AD &D Suppl AD &D
Basic Dep Life Suppl Dep Life
Account Number: 8
Class: All
Signature:
Printed Name:
Title:
Should you have any questions or concerns regarding this request, please feel free to contact me at the
telephone number below.
Jen Dehn
Account Manager
612- 342 -3253
ING Internal Servicing /Sales Ir
Primary Selling Office:
Primary Servicing Office:
Primary Sales Representative:
Primary Client Representative:
Implementation Manager:
formation
Minneapolis Qr'
Minneapolis , /V\
Bill Manning
Jen Dehn
N/A