Plan Change Forms

PLAN CHANGE FORMS

The following forms are available to print and either mail or fax to our office.

Bank Draft and Credit/Debit Card Authorization
Authorize electronic debit entries to your checking or savings account or from your credit or debit card for your premiums.  If you are starting this service or changing banks you should complete this form.

Policy Changes
Use this form to make changes in your policy such as change of policy owner, beneficiaries, or name.

Assignment
Assign the benefits of the policy to a third party, mostly to funeral homes.

Release of Assignment
Used by the assignee to acknowledge the release of their assignment on a policy and removing their ability to claim benefits.

Cancellation Request
Cancel a policy you currently own.

Policy Reinstatement Request
For application forms L-222, L-222D, Term 5R
For application form L-222A
For application form L-222J
For application form Term
For application form L-222B
For application form JT25

Annuity Forms
Annuity Withdrawal
Annuity Roll Over
Annuity Replacement
Annuity Suitability Analysis

Claim Related Forms
Claim Form
Affidavit of Lost Policy
Assignee Acknowledgment – required in all cases in which the policy benefits are assigned.
Release of Medical Records – used to allow us to received medical records of the insured, in case it is needed for underwriting or claim processing.

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