Protecting your privacy

In the interest of keeping your personal information secure and to protect against the possibility of fraud or identity theft, we will need to verify your identity before we release any policy forms. Please fill out the form below and a member of our team will contact you.

Once your identity has been verified, we will send you the appropriate form.

Forms currently available:

  • Change of Owner
  • Change of Name or Address
  • Change of Beneficiary
  • Claim for Total Disability/Premium Waiver Benefits
  • Bank Draft Change Form (To be used when banking information has changed. *Any changes to a recurring bank draft (e.g. change of draft date, cancellation, changes to bank information) must be made 3 business days prior to the current bank draft date before the change will take effect.)
  • Nursing Home Waiver Claim Form
  • Sick Benefit Claim
  • Death Claim Form
  • Surgical and Permanent Disability Claim
  • Direct Deposit Agreement


Policy Form Request