Customer Forms

This section provides you with a list of downloadable customer forms for you to fill-out should you have requests or claims against your policy.

Living Claim Forms

Attending Physician Statement for Continuance of Total Disability Certificate of Attending Physician for Hospitalization/ Medical Reimbursement Claimant Statement for Continuance of Total Disability Claimant Statement for Total Disability Claimant Statement for Hospitalization/ Medical Reimbursement

Death Claim Forms

Certificate of Attending Physician for Death Claim Claimant Statement for Death Claim Deceased Information Form Joint Affidavit of Identity for Beneficiary/ Claimant Joint Affidavit of Identity for Insured

Customer Request Forms

Address and Phone Update Form Cash Surrender Request Form Health Statement Form Indemnity Agreement Surrender Form Investment Change Request Form Policy Assignment Form Policy Cash Disbursement Request Form Policy Loan Request Form Request for Issue of Copy of Lost Policy Indemnity Agreement Form Request for Policy Change Form Futurefund Agreement Form W-9 Form (Request for Taxpayer Identification Number and Certification) W-8 BEN Form (Certificate of Foreign Status of Beneficial Owner for United Stated Tax Withholding) Waiver of Reporting Information to the Internal Revenue Services (IRS) Department of the U.S.

Auto-Pay Enrollment Forms

Credit Card Authorization to Debit Account