Service Forms

For changes to your Life Insurance & Cash Accumulation Plan, use one or more of the forms below:

For use when you want to make a change to your banking information

For use when you need to do a name change, release of assignment, address change, transfer ownership, elect automatic premium loan, beneficiary change, or policy loan

APPLICATION FOR POLICY CHANGE

For use when you want to make other changes to your policy

CHANGE OF BENEFICIARY DESIGNATION

For use when the owner/insured wants to change the beneficiary

ANNUITY REQUEST FOR SERVICE

For use when you want to make a change of name, beneficiary or transfer of ownership

ADDITIONAL FLEXIBLE PREMIUM ANNUITY CONTRIBUTION

For use when making additional contributions to your annuity

PARTIAL WITHDRAWAL OR SURRENDER (Not for policy cancellation)

For use when you need to make a partial withdrawal or to surrender your annuity

W-9 Form

For use in conjunction with the partial withdrawal or surrender annuity forms

APPLICATION FOR REINSTATEMENT

For use when you have allowed your coverage to lapse but want to reinstate

CLICK ON YOUR STATE

Arizona, Arkansas, California, Colorado, Connecticut, Florida, Kansas, Kentucky, Louisiana, Maine, Maryland, Michigan, Minnesota, Nebraska, New Hampshire, New Jersey, New Mexico, North Carolina, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Vermont, Virginia, Washington DC, Washington, West Virginia, Wisconsin ALL OTHER STATES

DISABILITY CLAIM FORM

For use when you want to file a claim for the disability benefit

DISAIBLITY CLAIM - EMPLOYER STATEMENT

For use when you have a disability that is employment related

ATTENDING PHYSICIAN'S STATEMENT OF DISABILITY

For use when the claim process requires a statement from your doctor

PROOF OF DEATH (ALL STATES EXCEPT ILLINOIS)

For use when an insured is deceased

PROOF OF DEATH (ILLINOIS ONLY)

For use in Illinois when an insured is deceased