Policyowner Service Request Forms

Application for Policy Changes Part I - for states other than New York 
Application for Policy Changes Part I - for New York only
Use the Application for Policy Changes Part I for:

  • Address change
  • Automatic premium loan
  • Beneficiary change
  • Cash surrender
  • Dividend option change
  • Dividend withdrawal
  • Duplicate certificate
  • Mode change
  • Name change
  • Non-forfeiture option change
  • Non-forfeiture provision
  • Ownership change
  • Partial surrender/withdrawal
  • Policy loan
  • Premium change
  • Release assignment
  • Signatures
  • Taxpayer identification number

Request for EFT Premium Paying Plan
Use the Request for EFT Premium Paying Plan to authorize premium payments via electronic funds transfer.

Mail completed and signed forms to P.O. Box 1381, Binghamton, NY 13902-1381 or fax to 1-866-253-9459.