VLCT Group Services has made a number of its important forms available online. Our most frequently used forms can be filled out and submitted online; others are available for printing.
How Can We Help You?
Request More Information About Insurance & Risk Services
Complete and submit online
Quotation Request
Request a Quote Online
Complete and submit online for group life, short & long term disability, and long term care
Health
Member Information & Education Request FormDownload, print and completeCIGNA Enrollment / Change Form
Download, complete and mail or fax to address/no. at bottom of formCIGNA Medical Claim Form
Download and complete CIGNA Prescription Claim Form
Download and completeCIGNA Affidavit of Domestic Partnership
Download, print and complete
Dental
Northeast Delta Dental Enrollment / Change Form
Download, print and complete
Northeast Delta Dental Termination FormDownload, print and complete
VLCT PACIF
General Coverage Questions
Complete and submit online
Certificate of Insurance Request
Complete and submit online
First Report of Injury Form
Complete and submit online
Property
Report Property Listing Change
Complete and submit online
Download, print and complete
Automobile
Vehicle Insurance Card Request
Complete and submit online
Download, print and complete
Liability
Liability Accident ReportDownload, print and complete
Unemployment
2007 Wage Report (Excel spreadsheet) (Download, complete and return to VLCT via e-mail, fax or U.S. mail.)
2007 Wage ReportDownload, print and complete
