Submit employee coverage changes
Thank you for contacting Unum. Please answer the following questions so we can review our records, determine eligibility for the service you have requested, and respond to your request in the most efficient and timely manner.

Note: Unum respects the privacy and confidentiality of the information our customers entrust to us. We will only forward requests for documents containing personal or confidential information to individuals who are authorized to receive that information according to our most recent records. Unum will notify you if we are not able to fulfill your request due to an authorization discrepancy.

* Required

Should we need additional information or experience a delay in completing your request, we want to contact you. Please provide us with the following information:
First and last name *
Phone number (123-456-7890 span) *
Please contact me via: *
To maintain a higher level of confidentiality, Unum will not fax the document(s) until we have contacted you and received your authorization to do so. If you have multiple Unum group policies and would like a copy of your contract for each policy, a separate request is needed for each policy.
Policy-division number (0123456-001 format) *
If you have multiple Unum group policies and would like to submit employee changes on several policies, a separate request is needed for each policy.
Company name *

Changes for first employee

Employee name (as shown on your premium statement)
Incorrect social security number (as shown on your premium statement)
New name
Correct social security number
Date of termination
New salary
Date of salary change

Changes for second employee

Employee name (as shown on your premium statement)
Incorrect social security number (as shown on your premium statement)
New name
Correct social security number
Date of termination
New salary
Date of salary change

Changes for third employee

Employee name (as shown on your premium statement)
Incorrect social security number (as shown on your premium statement)
New name
Correct social security number
Date of termination
New salary
Date of salary change

Changes for fourth employee

Employee name (as shown on your premium statement)
Incorrect social security number (as shown on your premium statement)
New name
Correct social security number
Date of termination
New salary
Date of salary change

Changes for fifth employee

Employee name (as shown on your premium statement)
Incorrect social security number (as shown on your premium statement)
New name
Correct social security number
Date of termination
New salary
Date of salary change

Changes for sixth employee

Employee name (as shown on your premium statement)
Incorrect social security number (as shown on your premium statement)
New name
Correct social security number
Date of termination
New salary
Date of salary change

Changes for seventh employee

Employee name (as shown on your premium statement)
Incorrect social security number (as shown on your premium statement)
New name
Correct social security number
Date of termination
New salary
Date of salary change
Please indicate any additional information that will assist us in reviewing your request: