Life Forms

Change of Address Form: Use this form to change your address or phone number.

Authorization for the Use and Disclosure of Information: Use this form to grant covered entity permission to release information to designated individuals.

Accelerated Death Benefit Request: Use this form to make a request on your Accelerated Death Benefit on your policy (not applicable on all policies).

Policy Values Request Form: Use this form to surrender or take out a loan or partial withdrawal on your policy.

Policy Values Request Form for Oregon: Oregon customers, use this form to surrender or take out a loan or partial withdrawal on your policy.

Request for Service Form — Funeral Home: Use this form to change your name, update your address, change your beneficiary, or request a duplicate policy.

Request for Service Form for Oregon — Funeral Home: Oregon customers, use this form to change your name, update your address, change your beneficiary, or request a duplicate policy.

Request for Service Form: Use this form to change your name, update your address, change your beneficiary, or request a duplicate policy.

Request for Service Form for Oregon: Oregon customers, use this form to change your name, update your address, change your beneficiary, or request a duplicate policy.

Absolute Assignment Form: Use this form to change the ownership of your policy. This form is NOT to be used to assign benefits to others.

122817

WW-0023B
To Find Which of the Following Products Are Available in Your Area: