Request for Information and Individual Rates
Please complete the form below to get your available benefit options and rate information.
The information below will be forwarded to the Rhode Island agency servicing your
employer's account. You will be contacted at the phone number you provide at the times that
are convenient for you. If this is a service/claims inquiry, please see the tab above.
Your name:
 Pre:
Do you work for The State of Rhode Island?
 Yes
 No
If not, which city or town do you work for?
What department do you work in?
Your Date of Birth:
 Month:
 Day:
 Year:
Which product(s) are you interested in?
 Disability
 Accident
* Note - Your employer may or may not offer
every one of our available products.
 Life
 Cancer
What is the best way for us to contact you?
 Phone
 Email
Phone Number:
 Email Address:
Best day(s) for us to call you:
 S
 M
 T
 W
 T
 F
 S
Best time for us to call you is between:
For additional comments,
questions or instructions for
us to contact you, please use
the area to the right.
By pressing Submit I understand that coverage
cannot be obtained, modified or cancelled nor can
a claim be filed by submitting this form.
Colonial's Website
(click here)
Quick Clicks
Click here to download a Claim
Form?
Click here to download a
Request for Service Form to
make a change to your policy.
Make a Name Change, Address
Change, Beneficiary Change,
Payment Method Change,
Policy Cancellation and more
using this form.
Colonial Life
Home Office Mailing Address

For Claims:

Colonial Life & Accident Insurance
Company
P.O. Box 100195
Columbia, SC 29202-3195

All Other Correspondence

Colonial Life & Accident Insurance
Company
P.O. Box 1365
Columbia, SC 29202-1365

Fax Claims: 1-800-880-9325
© 2008 Colonial Life & Accident Insurance Company Colonial Life & Accident Insurance Company is a subsidiary of Unum Group

Colonial Life products are underwritten by Colonial Life & Accident Insurance Company. Coverage has exclusions and limitations that may
affect benefits payable. Coverage may vary by state and may not be available in all states. See your representative for complete details.
Colonial Life is the marketing brand of Colonial Life & Accident Insurance Company.