Medicare Supplement Forms
Request for Service Forms include:
- Ordering a duplicate policy
- Ordering duplicate ID Card
- Name Changes
- Address Changes
- Policy Cancellation
- Telephone Number Changes
- Payment Method Change
- Request to Reduce/Increase Benefits
Request for Service Form - ALL States: Download the form
Request for Service Form - MN: Download the form
Request for Service Form - WI: Download the form
Request for Bank Draft Payment: Download the form
Life Insurance Forms
Request for Service Forms include:
- Ordering a duplicate policy
- Name Changes
- Address Changes
- Change of Ownership
- Full Surrender
- Telephone Number Changes
- Request to Reduce Coverage
- Payment Method Change
- Cancellation of Riders
Request for Service Form - LIFE ONLY: Download the form
Beneficiary Change Request: Download the form
Distribution of Proceeds for Minor Beneficiary: Download the form
Electronic Direct Deposit Application for Annuity Payments: Download the form
Life Insurance Reinstatement Application - NE ONLY: Download the form
Life Insurance Reinstatement Application - OH ONLY: Download the form
Life Insurance Reinstatement Application-AR, CNMI, CO, GU, HI, IA, IL, IN, KS, KY, MI, NV, OK, TX, WA, WI, WY ONLY: Download the form
Life Insurance Reinstatement Application-MN ONLY: Download the form
Release of Assignment Request-LIFE ONLY: Download the form
Request for Bank Draft Payment: Download the form
Ordinary Life Insurance Reinstatement Application-MO, FSM, RMI, Palau ONLY: Download the form
Universal Life Insurance Reinstatement Application-MO, FSM, RMI, Palau ONLY: Download the form
Universal Life Reinstatement Application - AL ONLY: Download the form
Universal Life Request for Partial Surrender or Policy Loan Form: Download the form
Pacific Group Life Forms
Child with Disability Eligibility Form - FSM: Download the form
Claims Processing Report: Download the form
Distribution of Proceeds for Minor Beneficiary: Download the form
Enrollment Form - CNMI: Download the form
Enrollment Form - FSM: Download the form
Enrollment Form - RMI: Download the form
Evidence of Insurability - CNMI: Download the form
Evidence of Insurability - FSM: Download the form
Evidence of Insurability-Parent - RMI: Download the form
Evidence of Insurability - Parent - Spouse Child - RMI: Download the form
Release of Assignment - CNMI: Download the form
Request for Refund Form - CNMI: Download the form
Request for Refund Form - FSM, RMI: Download the form
Waiver of Premium Election Form - RMI: Download the form