Life Insurance Forms

Please select a topic from the PL list below.

Pacific Life Insurance Forms

Change Policy Information

Address Change Request

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

Ownership, Beneficiary, or Name Change Request Booklet

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

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)

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

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

Surrender Request

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

Withdrawal Request

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

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

Electronic Funds Transfer (EFT)

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

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 - PACIFIC DISCOVERY PROTECTOR IUL (PDP)

Used for PDP IUL product to request one-time transfers, payment transfers, Scheduled Indexed Transfers, or segment maturity reallocations.

Indexed Products Transfer - PACIFIC DISCOVERY XELERATOR IUL (PDX)

Used for PDX & PDX 2 IUL products to request one-time transfers, payment transfers, Scheduled Indexed Transfers, or segment maturity reallocations.

Indexed Products Transfer - PACIFIC HORIZON IUL

Used for Horizon IUL, Horizon ECV IUL & Horizon SIUL products to request one-time transfers, payment transfers, Scheduled Indexed Transfers, or segment maturity reallocations.

Indexed Products Transfer - PACIFIC INDEXED ACCUMULATOR (PIA & PIA 2)

Used for PIA & PIA2 IUL products to request one-time transfers, payment transfers, Scheduled Indexed Transfers, or segment maturity reallocations.

Indexed Products Transfer - PACIFIC INDEXED ACCUMULATOR (PIA 3, 4, 5, 6)

Used for PIA 3, PIA 4, PIA 5 & PIA 6 IUL products to request one-time transfers, payment transfers, Scheduled Indexed Transfers, or segment maturity reallocations.

Indexed Products Transfer - PACIFIC INDEXED ESTATE PRESERVER (IPEP)

Used for IPEP, IPEP2, & IPEP3 IUL products to request one-time transfers, payment transfers, Scheduled Indexed Transfers, or segment maturity reallocations.

Indexed Products Transfer - PACIFIC INDEXED PERFORMER LT (PIP LT)

Used to for PIP LT & PIP LT 2 IUL products request one-time transfers, payment transfers, Scheduled Indexed Transfers, or segment maturity reallocations.

Indexed Products Transfer - PACIFIC PRIME IUL

Used for PRIME & PRIME 2 IUL products to request one-time transfers, payment transfers, Scheduled Indexed Transfers, or segment maturity reallocations.

Indexed Products Transfer - PACIFIC TRIDENT IUL

Used for Trident IUL product to request one-time transfers, payment transfers, Scheduled Indexed Transfers, or segment maturity reallocations.

Indexed Products Transfer - PIA PROTECTOR (PIA PRO & PIA PRO 2)

Used for PIA Pro & PIA Pro 2 IUL products to request one-time transfers, payment transfers, Scheduled Indexed Transfers, or segment maturity reallocations.

Request Summary of Your Policy

Certificate of Insurance/Duplicate Policy Request

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

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

 

 

 

 

 

 

Please select a topic from the PL&A list below.

Pacific Life & Annuity Forms

Change Policy Information

PL&A Address Change Request

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

PL&A Ownership, Beneficiary, or Name Change Request Booklet

Used for ownership, beneficiary, or name changes and includes additional forms that may be needed for an ownership change.

Change Authorizations

PL&A Other Interested Party Authorization Request

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.

PL&A Transaction Authorization (For Telephone Requests)

This form is specific to Variable and Indexed Universal Life Policies. Use to authorize telephone requests for: policy loans, investment option changes, and/or payment and transfer instructions.

Take Money Out of the Policy

PL&A Loan Request

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

PL&A Surrender Request-NY

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

PL&A Withdrawal Request

This form can be used to request withdrawals of cash value on a life insurance or fixed annuity policy.

Make Blling Changes

PL&A Billing and Premium Change Request

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

PL&A Electronic Funds Transfer (EFT)

Used to establish and change EFT requests for premium payments on life insurance policies and policy loan repayments on life insurance policies only.

Make an Investment Change

PL&A In Force Variable Life Investment Option Services

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.

PL&A Indexed Products Transfer Request - IUL

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

PL&A Certificate of Insurance/Duplicate Policy Request

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

Request a Duplicatre Copy of Your Policy

PL&A Certificate of Insurance/Duplicate Policy Request

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

Please select a topic from the PL Promise Term list below.

PL Promise Term Forms

Change Policy Account Information

Address Change Request

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

Beneficiary Change Request

This form is used for beneficiary changes.

Name Change Request

This form is used for name changes.

Ownership Change Request

This form is used for ownership changes.

Policy Change Application Booklet, A20LYCHG - DE, ND, SD

This booklet used to request a variety of changes to an in force life insurance policy.

Policy Change Application Booklet, A20LYCHG-CA

This booklet used to request a variety of changes to an in force life insurance policy.

Policy Change Application Booklet, A20LYCHG-FL

This booklet used to request a variety of changes to an in force life insurance policy.

Policy Change Application Booklet, ICC20 A20LYCHG

This booklet used to request a variety of changes to an in force life insurance policy.

Reinstatement Application for Child Rider, A18LYRSC - DE, ND, SD

This form is used for reinstatement of a Child Rider on a lapsed policy.

Reinstatement Application for Child Rider, A18LYRSC-CA

This form is used for reinstatement of a Child Rider on a lapsed policy.

Reinstatement Application for Child Rider, A18LYRSC-FL

This form is used for reinstatement of a Child Rider on a lapsed policy.

Reinstatement Application for Child Rider, ICC18 A18LYRSC

This form is used for reinstatement of a Child Rider on a lapsed policy.

Reinstatement Application for Individual Life Insurance, A18LYRST - DE, ND, SD

This form is used for reinstatement of a lapsed policy.

Reinstatement Application for Individual Life Insurance, A18LYRST-CA

This form is used for reinstatement of a lapsed policy.

Reinstatement Application for Individual Life Insurance, A18LYRST-FL

This form is used for reinstatement of a lapsed policy.

Reinstatement Application for Individual Life Insurance, ICC18 A18LYRST

This form is used for reinstatement of a lapsed policy.

Trust Information

This form is used when the policy owner or beneficiary is a trust.

Billing Payments

Billing and Premium Change Request

This form is used for billing and premium changes.

Electronic Funds Transfer Authorization for Renewal Premiums

This form is used to establish and change EFT requests for premium payment.

Release of Assignment

This form is used to release a collateral assignment when a debt has been repaid on a collaterally assigned policy. A policy will remain collaterally assigned until this form is completed and returned to PL.

Change requests

Authorization to Exercise Ownership Rights

This form is used for policy owned by business entities and other organization, or for other ownership arrangements to notify PL who is authorized to sign on behalf of the Policy Owners when exercising the policy's ownership rights

Certificate of Insurance/Duplicate Policy Request

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

Collateral Assignment

This form is used to assign a policy as collateral security for an obligation owed to a bank, company or individual. It’s execution transfers certain contractual rights from the policy owner to the assignee

Other Interested Party Authorization Request

This form may be used to authorize an interested party, request and receive policy information, remove an interested party to stop/start duplicate mailing to an interested party.

Producer Change Request

This form is used to replace any existing Producer/Agency that services the policy/contract with the New Producer/Agency named

Withdrawal Requests

Surrender Request

This form is used for surrendering 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.