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Email address:

Petersen International Underwriters
23929 Valencia Blvd, Suite 215
Valencia, CA 91355
phone: 800-345-8816
fax: 661-254-0604
email: piu@piu.org
site designed by:
thedesignequation.com

Credentials

  1. Catalogue of Coverages
  2. Medical Applications & Brochures
  3. Disability Brochures (non-sport)
  4. Disability Applications / Forms (non-sport)
  5. Professional Athletes Brochures
  6. Professional Athletes Applications / Forms
  7. Life and Accidental Death Applications & Brochures
  8. Kidnap and Ransom Applications & Brochures
  9. Additional Questionnaires and Miscellaneous Forms
  10. State Requirement Forms

  1. Catalogue of Coverages
  2. Medical Applications & Brochures
    1. Online Major Medical *New*
      1. Apply Online

    2. The International Major Medical Plan
      1. Brochure and application
      2. Application only

    3. Worldwide Major Medical Plan
      1. Brochure and application
      2. Application only

    4. The Bridge Plan
      1. Brochure and application
      2. Application only

    5. Group International Major Medical Plans
      1. Brochure and application
      2. Application only

    6. Excess Major Medical
      1. Brochure and application

  3. Disability Insurance Brochures
    1. The Executive 400 Plan Brochure
    2. Disability Insurance Solutions Brochure
    3. Physicians and Surgeons High Limit Brochure
    4. Dentists High Limit Brochure
    5. Entertainment Disability Insurance Brochure
    6. Pilot Disability Insurance Brochure
    7. Top Hat Program Brochure
    8. Group Disability Insurance Brochure
    9. Buy Sell Funding Brochure
    10. 401(k) Completion Plan Brochure

  4. Disability Insurance Applications/Forms (Non-Sports)
    1. Personal Disability Application
    2. Contract Guarantee Disability Application
    3. Disability Buy In/ Buy Sell Application
    4. Disability Business Overhead Expense Application
    5. Disability Insurance Short Form (use only if specified by underwriters)
    6. Key Person Disability Application
    7. Loan Indemnification Disability Application
    8. Pilot Disability Insurance Application
    9. Salary Continuation Disability Application
    10. Severance Disability Application
    11. Business Overhead Worksheet
    12. Buy Sell Questionnaire

  5. Professional Athletes Brochures
    1. Professional Athlete High Limit Disability Insurance Brochure
    2. Racer Cover Disability Insurance Brochure
    3. Pro Jockey Disability Insurance Brochure
    4. The Links Disability Insurance Brochure

  6. Professional Athletes Applications
    1. Professional Athletes Long Form Application
    2. Professional Athlete Short Form Application (use only if specified by underwriters)
    3. Professional Athlete Renewal Application Form (use only if specified by underwriters)
    4. Athlete Injury/ Diagnosis Prognosis Form
    5. Professional Athlete Proposal Request Questionnaire
    6. Professional Motorsport Questionnaire

  7. Life and Accidental Death Applications & Brochures
    1. High Limit Accident Insurance
      1. Get a Quote/Apply Online
      2. Brochure and application
      3. Application only

    2. International and Special Use Term Life Insurance
      1. Brochure and application
      2. Application only

    3. Confidential Insurable Interest Life Insurance
      1. Brochure and application
      2. Application only

  8. Kidnap and Ransom Applications & Brochures
    1. Kidnap and Ransom Insurance
      1. Brochure and application
      2. Application for individual cover
      3. Application for corporate cover

  9. Additional Questionnaires and Miscellaneous Forms
    1. Amateur Motorsport Questionnaire
    2. Assignment of Benefits
    3. Mountaineering Questionnaire
    4. Physicians Confidential Medical Report (MD Exam Form)
    5. Aviation Questionnaire
    6. Prognosis Form (non Athlete)
    7. Underwater and Sky Sport Questionnaire
    8. Confidential Financial Statement
    9. Authorization
    10. Privacy Notice
    11. Business Travel Accident Questionnaire

  10. Misc. State Forms
    1. Arkansas
    2. California
    3. Connecticut
    4. Kansas
    5. Louisiana
    6. Massachusetts
    7. Mississippi
    8. Nebraska
    9. New Jersey
    10. New Mexico
    11. New York
    12. North Carolina
    13. Ohio
This site is intended for use by Professional Insurance Producers only. If you are not a licensed insurance producer you are encouraged to review anything on this site with a local insurance specialist.