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Please click on the appropriate form listed below. Once completed, hit SUBMIT and it will be sent directly to us.

Individual Short Term Disability Coverage
This form is for all Individual Short Term proposals.

Individual Long Term Disability/ Business Overhead
This form is for all Individual Long Term Proposals and all Business Overhead Expense cases.

Buy Sell Proposal Request
This form is for Buy / Sell monthly, down payment, or lump sum benefit amount proposals.

Multi-Life Offer Request Form
Use this form for cases with three or more lives and for which you would like to propose an executive carve out program, a retirement completion program, a group supplement program, or other type of multi-life disability income benefit program. This form will allow us to negotiate/request Guarantee Issue or Simplified offers from the insurance carriers. Additionally, a census in an Excel Spreadsheet is required including:

Company Name and Address
Employee Name (First, Last)
Resident State
Bonus/ Commission

Click here for our pre-formatted excel spread sheet census form.

Once completed, please e-mail census to info@drgdi.com.

Please feel free to contact us at 800-945-9719 to discuss the case, underwriting concerns, program design, and competition and carrier selection.

General turn around time is within 24 hours for most Individual / Business Overhead and Buy-Sell requests.

Please allow additional time for Multi-Life requests.



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