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Request for Change of Policy Record Form

When to Use This Form

The ``Request for Change of Policy Record" is the form you need to use when submitting the following changes to your life insurance policy:

  • Change of Primary or Contingent Beneficiary
    Note:  If there is more than one Primary or Contingent Beneficiary, please make sure each designee has been assigned a percentage of the death benefit proceeds.  Specific dollar amounts cannot be used. Allocation of proceeds must be indicated in percentages and the total must equal 100% for each type of beneficiary.
  • Change of Policyowner
  • Change of name of the Policyowner, Insured, Assignee, etc.
  • Address Change for policy correspondence
  • Elect Premium Default or Non-forfeiture Option
    These are possible alternatives to payment of your premium

To access our Request for Change of Policy Record form, please click on the button below.

Change of Policy Record form

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Copyright ©2000 Aurora National Life Assurance. All rights reserved. Site last modified: Nov 29, 2000