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Information listed below in Italic is needed for experience-rating purposes (100 lives for Dental, 200 Additional Information (if applicable) lives for STD, and 500 lives for Life and LTD.  Carrier history for the last 3-5 years. DATA TO SUBMIT FOR A PROPOSAL  Description of current funding arrangement. Information Needed for All Products  Reason group is out to bid. A  Census (Sent Electronically) L  Date of Birth, Gender, Class Dearborn National Group Products L  Nature of Business/SIC Code  Basic & Voluntary Life/AD&D and Dependent Life  Copy of current benefit booklet or contract, and plan  Basic & Voluntary Short-Term Disability P design to quote (if different than in-force).  Basic & Voluntary Long-Term Disability R  Current rates and renewal rates, if available.  Supplemental Life and Dependent Life O  Employer contribution for employees (and  Basic & Voluntary PPO Dental* D dependents, if applicable). U  Definition of eligibility Plus Value-Added Services such as: C  Rate history during the experience periods.  Beneficiary Resource Services  Travel Resource Services T  Plan changes during the experience periods.  EAP Programs  Disability Resource Services S  Enrolled lives separated by year and coverage.  Employer FICA Match Services  Online Evidence of Insurability  Telephonic Claim Intake (Employee)  Online Will Preparation  FMLA D Additional Information Needed for Dental Products  Dearborn National Freedom Account  Census E  Dental tier and zip code *NOTE: some products may not be available in all states. Services may be N  Premium and paid claims history for 2 years. available to certain size case only. T  Separated by year and plans, if applicable. A  Out of network reimbursement level. FINANCIAL STRENGTH L The A.M. Best Company, as of January 27, 2010, rated Fort Additional Information Needed for Life Products Dearborn Life A+ (Superior).1 In its most recent report,  Census Standard & Poor’s rated Fort Dearborn Life A+ (Strong) for its  Benefit amount for each offered Life product. financial strength in its most recent report. Fort Dearborn Life is a wholly owned subsidiary of Health Care Service Corporation L  Salary  Premium and paid claims history for 3-5 years. (HCSC), a Mutual Legal Reserve Company, one of the largest I  Separated by year and line of coverage. non-investor-owned mutual insurance companies in the United F  Dollar amount of each claim. States. E  Paid and pending waiver of premium claims (date approved or terminated, amount of coverage and STRONG DENTAL NETWORK coverage type). Dearborn National Group Dental offers flexible plans with competitive rates supported by a dental network that has more Additional Information Needed for LTD Products than 153,000 dental access points, the largest network in the  Census United States.  Occupation, salary, and benefit amount.  Premium, paid claims, incurred claims, and Send all proposals to: Sales Representative L reserves for 3 years.  Open claims T Contact Information D  Age at disability/DOB, nature and date of Sales Representative disability, gross/net benefit, offset information, Dearborn National reserve amount per claim, and benefits paid to date Street per claim. City, State, Zip  Closed claims. Office – Cell – Additional Information Needed for STD Products Fax – S  Census  Salary and benefit amount. T This is a highlight of the benefits offered. Availability, exclusions, limitations  Premium and paid claims history for 3 years. D and reductions may apply - contact your Dearborn National sales representative  Separated by year. for further details or if you have any questions.

Products and services marketed under the Dearborn National™ brand and the star logo are underwritten For all products, experience by month for premium, claims, and enrollment and/or provided by Fort Dearborn Life Insurance Company® and Fort Dearborn Life Insurance Company® information is preferred. of New York.

Please visit our website at www.DearbornNational.com. 1 A.M. Best Company rates the overall financial condition of a company using a scale of A++ (Superior) to F (In Liquidation).

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