Life Insurance

Form

Use this form to...

Notes

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

Must provide legal proof of name change as noted on the form

Operation/Dismemberment Claim

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