Revised Military Disclosure Form

Effective Monday, April 3, 2023, the Disclosure for Life Insurance Sales to Active-Duty Military Service Members form (ORD 114442 2023) has been updated to reflect changes to cost of coverage and definition of active-duty service member.

The Disclosure for Life Insurance Sales to Active-Duty Military Service Members (ORD 114442 2023) has been revised as follows:

• Page 1: Definition updated to clarify Ohio’s definition of active duty.
• Page 1: Disclosure to customer updated.
• The form carries a revision date of 2023.

The new form should be submitted with applications with a Part 1 date of Monday, April 3, 2023. Older versions of the form will continue to be accepted until Monday, June 5, 2023.

The revised form is available on the PruXpress website.