Designation and Name Change Form
Use this form to change a name, address, beneficiary, owner or payor.
Policy Change Form
Use this form to change an automatic premium loan option, dividend option, premium mode or premium amount, request a duplicate certificate, release an assignment, or request that the policy status be changed to reduced paid-up insurance or extended term insurance.
Request for Values Form
Use this form to surrender a policy for cash or to request a policy loan, partial surrender or withdrawal, dividend withdrawal, minimum required distribution from an annuity contract, or to apply the policy value to pay future premiums
Application for Policy Changes - New York
Use this form to request any policy change in New York.
Application for Policy Changes - all other states
Use this form to request any policy change in any state other than New York.
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.