Life Insurance Forms

Please select a topic from the list below.

Change Policy Information

Address Change Request

Form #15-29022-01

This form is used to request an address change on a life insurance or fixed annuity policy.

Ownership, Beneficiary, or Name Change Request Booklet

Booklet contains following form #’s 15-43505-06; 15-47910-00; 15-40749-02; 15-16547-09

This booklet is used for ownership, beneficiary, or name changes and includes additional forms that may be needed for an ownership change.

Change Authorizations

Other Interested Party Authorization Request

Form #15-30276-03

This form may be used for a life insurance or fixed annuity policy to: authorize an interested party, request and receive policy information, remove an interested party, or stop/start duplicate mailings to an interested party.

Transaction Authorization (For Telephone/Electronic Requests)

Form #15-40749-03

This form is used to authorize the Policyowner to make telephone or electronic requests that are available on the policy, or to authorize a party other than the policyowner to make telephone or electronic requests. In the state of WA, if another party is appointed, a witness's signature is required.

Take Money Out of the Policy

Loan Request

Form #15-29028-26

This form is used to request a loan on a life insurance policy.

Surrender Request

Form #15-21075-10

This form is used to surrender/cancel an existing life insurance or annuity policy.

Withdrawal Request

Form #15-29029-25

This form can be used to request withdrawals of cash value and dividends and surrender paid-up additional insurance on a life insurance or fixed annuity policy.

Make Billing Changes

Billing and Premium Change Request

Form #15-29023-02

This form is used to request changes to billing and premium information on in-force life insurance policies.

Electronic Funds Transfer (EFT)

Form #15-23420-13

This form is used to establish and change EFT requests for premium payments on life insurance & fixed annuity policies and policy loan repayments on life insurance policies only.

Make an Investment Change

In Force Variable Life Investment Option Services

Form #15-30729-26

This form is used to allocate payments, rebalance and/or transfer investment options using the variable transfer services available on your variable life insurance policy.

Indexed Products Transfer Request-IUL

Form #15-30727-13

This form is used to request one-time transfers, payment transfers, scheduled indexed transfers or segment maturity reallocations. Transfer requests received later than 2 business days prior to the transfer date are not eligible for transfer until the next transfer date.

Request Summary of Your Policy

Certificate of Insurance/Duplicate Policy Request

Form #15-29024-02

This form is used to request a Certificate of Insurance or a duplicate policy on life insurance or fixed annuity policies.

Request a Duplicate Copy of Your Policy

Certificate of Insurance/Duplicate Policy Request

Form #15-29024-02

This form is used to request a Certificate of Insurance or a duplicate policy on life insurance or fixed annuity policies.

This website or its third-party tools use cookies, which are necessary to its functioning and are required to achieve the purposes illustrated in our online privacy policy.