OE2024 – Insurance Selections

Name *

First

Last

AFLAC INSURANCE *

• I am currently an Aflac policyholder and have decided to make changes to my policy.
• I am currently an Aflac policyholder and have decided not to upgrade to any newer policies at this time.
• I am currently an Aflac policyholder and wish to cancel my policy/polices.
• I am currently NOT an Aflac policyholder and have decided to waive my opportunity to participate at this time.
• I am currently NOT an Aflac policyholder but am interested in becoming a policyholder.

Please select one.

GRANGE LIFE INSURANCE (through Sammons Insurance) *

• I am currently a Grange policyholder and have decided to make changes to my policy.
• I am currently a Grange policyholder and have decided not to upgrade to any newer polices at this time.
• I am currently a Grange policyholder and wish to cancel my policy/polices.
• I am currently NOT a Grange policyholder and have decided to waive my opportunity to participate at this time.
• I am currently NOT a Grange policyholder but am interested in becoming a policyholder.

Please select one.

CINCINNATI LIFE INSURANCE (through Sammons Insurance) *

• I am currently a Cincinnati Life policyholder and have decided to make changes to my policy.
• I am currently a Cincinnati Life policyholder and have decided not to upgrade to any newer polices at this time.
• I am currently a Cincinnati Life policyholder and wish to cancel my policy/polices.
• I am currently NOT a Cincinnati Life policyholder and have decided to waive my opportunity to participate at this time.
• I am currently NOT a Cincinnati Life policyholder but am interested in becoming a policyholder.

Please select one.

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