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.

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, Term 5R
For application form L-222A
For application form L-222J – Preferred and Standard
For application form L-222J – Modified
For application form Term
For application form L-222B
For application form JT25

Annuity Related Forms
Annuity Withdrawal
Annuity Transfer
Annuity Replacement
Suitability Analysis
Required Minimum Distributions
PTE 84-24

Claim Related Forms
Claim Form
Affidavit of Lost Policy
Assignee Acknowledgment
Release of Medical Records

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