E-Signature Consent

Client Form ID (Used For Landing Page Redirection)

Your Name*

First NameLast Name

Your Employer*

Primary Email Address*

example@example.com

Primary Phone Number*

Please enter a valid phone number.

Your State of Residence*

Street Address

Street Address Line 2

State

Consent to use Electronic Records and Electronic Signature (ERSD)
Please read the information below containing certain disclosures regarding your consent to electronic records and electronic signatures. If you agree to this Electronic Record and Signature Disclosure (ERSD), please confirm such agreement by selecting the checkbox that follows before clicking ‘CONTINUE’. At any time, you may request that we email or mail you a copy of any record provided or made available electronically to you by us. You may request delivery of such copies from us by following the procedure below.

By clicking "Yes, I agree" or by clicking any box acknowledging an associated document or statement, I am confirming that:

I can access this information electronically, and I have read this ERSD.
I agree to use electronic records and signatures.
I acknowledge and agree to the content and terms of such document or statement and to providing my electronic signature thereto.
This agreement shall have the same force and effect as if I signed a paper copy of the document or statement.

By clicking on "Yes, I agree", I agree to conduct this transaction and all future transactions concerning this coverage and any other coverage with Unum electronically unless or until such time as I notify Unum that I am withdrawing my consent as described below. This includes the receipt of legally required disclosures or notices I receive electronically.

System Requirements
To retrieve documents provided here or on Unum's website, you must have access to a computer with the following: Microsoft Internet Explorer version 6.0 or higher; Adobe Acrobat Reader; and an Internet connection. To receive electronic communications from Unum, you must also have an e-mail account.

Consent Preference Changes
If you would like to change your preference, CLICK HERE to:

Withdraw your consent to conduct transactions by electronic means; or
Request a paper copy of any electronic document; or
Update your account information

If you decide to receive notices and disclosures from us electronically, you may at any time change your mind and tell us that thereafter you want to receive required notices and disclosures only in paper format. How you must inform us of your decision to receive future notices and disclosure in paper format and withdraw your consent to receive notices and disclosures electronically is described above. Please note that if you elect to receive required notices and disclosures only in paper format, it will slow the speed at which we can complete certain steps in transactions with you and delivering services to you because we will need first to send the required notices or disclosures to you in paper format, and then wait until we receive back from you your acknowledgment of your receipt of such paper notices or disclosures. Further, you will no longer be able to use our system to receive required notices and consents electronically from us or to sign electronically documents from us.

By clicking "Yes, I agree" or by clicking any box acknowledging an associated document or statement, I am providing my agreement for all purposes. This agreement shall have the same force and effect as if I signed a paper copy of the document or statement. By clicking on "Yes, I agree", I agree to conduct this transaction and all future transactions concerning this coverage and any other coverage with Unum. This includes the receipt of legally required disclosures or notices I receive electronically.*

Yes, I agreeNo, I don't agree