Summary
The purpose of this form is to authorize Massachusetts Mutual Life Insurance Company (“MassMutual”) to
release information, including non-public personal health and financial information, about the Proposed Insured (also referred to as “I” or “me” or “my”) to the Agent or Broker who submitted an application to MassMutual on my behalf and/or the General Agency with whom the Agent or Broker is contracted (collectively the “Agent/ Broker/Agency”) and to be used as described on the PDF.
Body
The purpose of this form is to authorize Massachusetts Mutual Life Insurance Company (“MassMutual”) to
release information, including non-public personal health and financial information, about the Proposed Insured (also referred to as “I” or “me” or “my”) to the Agent or Broker who submitted an application to MassMutual on my behalf and/or the General Agency with whom the Agent or Broker is contracted (collectively the “Agent/ Broker/Agency”) and to be used as described on the PDF. Click here or see attachments for the form.