Form Name & Description	Availability
AEGIS PACIFIC Insurance Service Forms
Simplified Group Health Plan Employee Census	On Request
Group Health Plan Employee Census (51+ Employees)	On Request
Letter of Exclusive Authorization	On Request
Suggested Broker of Record letter	On Request
Producer's Agreement	On Request
Producer's Information Form (AgntInfo.doc 07/00)
Blue Shield of California Forms
Employee Applications for 2-50 Employee (11/06) Employer Questionnaire for 15-50 Enrolling Employees (07/05) Request for Contract Change (02/07) Small Group Enrollment Affidavit Subscriber Change Request Forms  (06/05) This form is used to make changes in group subscriber information and states.  Examples: effective date, membership number, plan choice, add or delete dependents, change of address Subscriber Change Request Forms  - Spanish Version (06/05) This form is the same as above translated to Spanish. Request for Proposal Form Employer Notification of Qualifying Event Under Cal COBRA (SB719)  (C13140 06/00)  This form is completed by the employer at the time of the qualifying event of the employee and mailed or faxed to Blue Shield. Affidavit of Domestic Partnership  This form is completed by the employee at enrollment. Sub-Producer Information Form  This form is completed by an agent when signing up with AEGIS PACIFIC as a sub-producer.
DentAssure Forms
Indemnity Plan - Request for Quotation
PPO Plan - Request for Quotation
Scheduled PPO Plan -  Request for Quotation
DentAssure RFQ Forms Package  This file includes each Request for Quotation form.
DentAssure Sales Brochure
Employee Enrollment Card	On Request
Master Group Application	On Request
DentAssure Enrollment Forms Package This file includes the Master Application and the Employee Enrollment Card.

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