Equitable Reserve Association

This form contains the application for Disability Insurance benefits and an authorization/notice to obtain information. The form is state-specific. Please choose the appropriate form based on your state.

• All States EXCEPT CO, IL, IN, KY, MN, OH (PDF)
• State of Colorado (CO) (PDF)
• State of Illinois (IL) (PDF)
• State of Indiana (IN) (PDF)
• State of Kentucky (KY) (PDF)
• State of Minnesota (MN) (PDF)
• State of Ohio (OH) (PDF)

All forms are provided in PDF format and will require the Adobe Acrobat Reader.