"Solid as the Rockies"
Use this form to...
Request to Change Beneficiary (Insurance)
Change the beneficiary of your certificate
All signatures must be notarized
Request to Change Name of Insured
Change the name of the insured on your certificate
Must provide legal proof of name change as noted on the form
Request to Change Owner
Change the owner of your certificate
Request and document Operation and/or Dismemberment benefit claims
Must be completed and signed by the Physician or Surgeon, or accompanied by billing information to support claim
Application for Cash Surrender
Request cash surrender of life certificate
Must be signed by the insured and payer/owner