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.