Electronic and Paper Forms

Finally, a simple way to complete and submit insurance forms. KLN has developed a simplified way for you to complete and submit all your insurance forms online. You just point and click on the form you require, complete it on line, print a copy for your files, and hit a button to e-mail it to KLN! You can accomplish this without ever leaving the screen.
Of course if you prefer you can always print the form complete it and fax it to us. I hope this new functionality makes your interactions with us easy and efficient. As always your comments and suggestions are welcome.
Sincerely,
Kevin Kelly
President
Please click on the form you need:
Darwin Select Insurance Company
  1. Indication Request – Physicians and Surgeons
  2. Application Completeness Checklist
  3. Physicians and Surgeons Application
  4. Partnership/Corporation Application
  5. Supplemental Claim Form
ProMutal Group / ProSelect
  1. Application Completeness Checklist
  2. Physicians and Surgeons Application
  3. Partnership/Corporation Application
  4. Prior Acts Application
  5. Notice to New Applicants
  6. Supplemental Claim Form