The purpose of this form is simply to gather information to help complete an application for disability insurance.
If you apply for insurance you may be asked additional or different questions. Once you have completed this form, your agent will use this information to complete your official application and email it to you for your review.
We value your privacy. Due to the confidential nature of the questions being asked, we limit the amount of time that we maintain your information. Once you complete the questionnaire, your answers are delivered securely to your agent, who will complete your official application and send to you securely for your review and signature.
Please call your agent, Todd Talbot at (205) 586-5007 with any questions. Thank you for working with us on your coverage.
Ashford Advisors is an independent agency authorized to offer products of The Guardian Life
Insurance Company of America (Guardian), New York, NY and its subsidiaries, and is not an affiliate or
subsidiary of Guardian. The Guardian Logo is a registered service mark of Guardian, used with