Reliable Policy Management North Carolina Product Listing, Forms and Documentation

The following products are available. For a detailed summary of each product, please refer to the Agent Guidelines manuals for each product.

• Manufactured/Mobile Home/Modular Home Insurance - not writing new business in all counties
• Prime AD and Family Plan Accidental Death & Dismemberment (AD&D)
• Motor Club Membership

Forms and Documentation:
     The date following the product is the last update.

• Triangle Life Insurance Company (Prime AD):

• Prime AD - NC Agent Guidelines Edition 8-(7/08)
• Agency/Agent Licensing Forms Package (8/08)
• Agency Fact Sheet (8/08)
• Cancellation Request Form (8/08)
• Claim Form for Accidental Death, Dismemberment or Loss of Sight
• Endorsement Form (8/08)
• Forms Package - all NC Prime AD forms (8/08)
• Supply Order Form (8/08)
• W-9 Form

• American Guaranty Insurance Company (Family Plan):

• Family Plan-NC Agent Guidelines Edition 8-(7/08)
• Agency/Agent Licensing Forms Package (8/08)
• Agency Fact Sheet (8/08)
• Cancellation Request Form (8/08)
• Claim Form for Accidental Death, Dismemberment or Loss of Sight (8/08)
• Endorsement Form (8/08)
• Forms Package - all NC Family Plan forms (8/08)    
• Supply Order Form (8/08)
• W-9 Form

• NC Roadmaster (Motor Club) - underwritten by Nation Safe Drivers:

• Roadmaster Motor Club Plan Edition 2-(8/08)
• Agency/Agent Licensing Forms Package (8/08)
• Agent Application
• Agency Fact Sheet (8/08)
• Cancellation Request Form (8/08)
• Claim Form
• Forms Package - all NC Roadmaster forms (8/08)
• Member Address Change Form (8/08)
• RPM Roadmaster Agreement
• Supply Order Form
• Transmittal Form
• W-9 Form

Note: Adobe Reader version 6.0 or later is required to view and print  these forms.