Client Services


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Tim Wiedman Associates
--Where Serving you is our Number One Priority--
Client Services for Fort Dearborn Life
Forms for Fort Dearborn Life: For additional infomation from Fort Dearborn Life visit their website at

The following forms are for new groups setting up their plans. These should be returned to Tim Wiedman Associates:
Small Group Employee Application
Employer Application

To add a new employee, or change the status (ie add/remove child, etc) for established groups, use the employee app above. After completion, fax to us at (260) 248-2558. To terminate an employee from the plan, call us at (800) 967-6205. When adding a new employee, be sure to complete the request within the time allowed for your waiting period. If you do not remember your waiting period, please contact us at (800) 967-6205.

Note: These forms are in Adobe Portable Document Format (PDF). In order to view PDF files, you will need the Adobe Acrobat Reader. The reader is available for downloading free of charge at