Online Forms

Wichita National Life online forms are in PDF format.
If you have any questions regarding these forms, please contact Ron Parker at 580-353-5776.

Application 1  (Under $100,000)

Application 2  ($100,000 and Over)

Health Statement

HIPAA Authorized Release

Insured’s Statement/Affidavit

Death Claim

A&H Claim Progress Report

A&H Initial Claim for Benefits

Single Premium Term Application

QUALITY OF SERVICE AND RELIABILITY

Since 1957

Known throughout Oklahoma and Arkansas banking industries as being the “OLD RELIABLE” credit insurance company. Recently licensed in Texas.