New Life Insurance Application
and Supplemental Forms
EFFECTIVE JUNE 27, 2016. We’re pleased to introduce our new life insurance
application, which reflects several improvements to make it easier for you to provide
an in-good-order application.
IMPROVED LAYOUT – more space to improve readability, navigation and size of response fields
BUILT IN “QUICK TIPS” – offering guidelines on completing key sections of the application
ENHANCED QUESTION DESIGN – using simplified language and question style to help ensure
in-good-order submissions
What You Need to Know
What changes were made to the application and
supplemental forms?
• Same application for Term and Perm. Use the new Application for Life
Insurance for both Permanent and Term products; the Application for
Term Insurance (NB5092) has been discontinued.
• Different form numbers for Compact and Non-Compact states.
– For Compact states (see side-bar), check for the “ICC 16” prefix in front
of a NB6000 series form number
– For Non-Compact states, look for the state-specific version of the
NB5000 series
What is a “Compact” state?
The Interstate Insurance Compact
(Compact) benefits state insurance
regulators, consumers and the
insurance industry. Currently with 44
member states, the Compact allows
for the central filing of forms for
insurance products. For a complete
list of compact states, see page 2.
• All supplemental forms have also been updated. Please use the corresponding supplemental
forms for your applications, i.e., for Compact states, look for the “ICC 16” prefix.
• Supplemental form for survivorship applications. For survivorship cases, use Survivorship
Supplement for Second Life (Compact version: ICC 16 NB6001; Non-Compact version: NB5211), as this
information will no longer be collected on the Application for Life Insurance.
• One form for alcohol and drug use. Now called the Drug and Alcohol Questionnaire
(Compact version: ICC 16 NB6008; Non-Compact version: NB5022).
Are the new application and supplemental forms approved in all states?
The new application and supplemental forms have been approved in all states except New York.
When should I begin using the new application and supplemental forms?
You can begin using the new application and supplemental forms for all states except New York as of
June 27, 2016. Please transition to using the new forms within 30 days of the effective date.
LIFE-5882A 06/16
Where can I access the new application and supplemental forms?
All John Hancock life insurance forms are available on your John Hancock producer website, JH Illustrator,
or through the other forms’ vendors that John Hancock supports. We encourage you to use the
application kitting feature available in these tools to ensure you are downloading the correct
versions of the new application and forms.
Can I complete the new application/supplemental forms via e-App?
The revised application and supplemental forms are not currently available via e-App/iPipeline’s iGO, but will
automatically transition to the online wizard in the coming months.
Can I use the new application to apply for easy-issue products, such as
SmartProtect™ Term with Vitality and Simplified Life?
No, the new application should not be used to apply for these products. Please continue to follow the
specified application process when applying for these easy-issue products. For more information about
SmartProtect Term with Vitality, visit JHRedefiningLife.com; for details on applying for Simplified Life, go to
JHSimplifiedLife.com.
Interstate Compact States
WA
MT
ME
ND
OR
VT
MN
ID
WI
SD
WY
MI
UT
CA
AZ
PA
IA
NE
NV
IL
CO
KS
OK
NM
MD
OH
IN
WV
MO
VA
KY
AR
SC
AL
RI
NJ
DE
DC
NC
TN
MS
TX
NH
MA
CT
*
NY
GA
COMPACT STATES
NON-COMPACT STATES
LA
AK
FL
HI
*The new application and supplemental forms have not been approved in New York.
For Agent Use Only. This material may not be used with the public.
Insurance policies and/or associated riders and features may not be available in all states.
Insurance products are issued by John Hancock Life Insurance Company (U.S.A.), Boston, MA 02110 (not licensed in New York) and
John Hancock Life Insurance Company of New York, Valhalla, NY 10595.
MLINY062316128