IMPORTANT: MUST BE COMPLETED BY ALL EMPLOYEES IPS INITIAL GROUP OFFERING Long Term Care Insurance Name* Enter first and last name Your Email* Enter a valid email Daytime Phone Number* Phone number where you can be contacted Please confirm your plan to accept or waive participationI am interested in learning more about Transamerica Long Term Care Program.I am not interested at this time Acknowledgement*I confirm that I have been offered this coverage during the initial group enrollment of Transamerica Long Term Care.
