PRODCAT Life Forms

Download and print the form you need, then mail the completed form to us. Click a form category to show only those forms. If the form you need isn't available below, please contact us.

Change of Beneficiary Form - Form #13977
Use the change of beneficiary form to change a primary or contingent beneficiary designation.

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Additional Beneficiaries Designation Supplement to Beneficiary Change Request - Form #17963
Use this form to elect Additional Beneficiaries for your contract(s), if you do not have enough space on Form 13977 (Beneficiary Change Request).

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Change of Beneficiary for Indexed Survivorship Universal Life Supplemental Insured Rider Form
Use this form to change the beneficiaries for your Indexed Survivorship Universal Life (ISUL) Supplemental Insured Rider.

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Trust Verification Form - Form #16541
Used by policy owners, in lieu of the complete copy of the trust, to certify the name, date and trustees of their trust.

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Bank Authorization Form - Form #15036
To have your premium payments automatically deducted from your checking account, submit this form and a void check or Specification Sheet from your account. Please contact the Home Office at least ten days prior to your draft date for any changes to an existing Pre-Authorized Check agreement.

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Policy Loan Request Form - Form #15035
Used by policy owners to request a loan from their life insurance policy.

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Change of Ownership Form - Form #15028
Use this form to transfer the ownership of your policy.

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Authorization to Release Information - Form #17624
Use this form to agree to an information release.

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Address Change Request - Form #19400
Used by policy owners to notify us in the event of a change to the current address on file.

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Name Change Request - Form #17884
Used by policy owners to notify us in the event of a legal name change.

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Request for Co-Ownership - Form #16283
This form is to be utilized any time there will be more than one owner.

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Pension Plan Verification - Form #17982
Use this form to verify your pension plan.

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Collateral Assignment – Form #15038
Use this form to assign the rights and privileges of your policy to another person or entity.

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Life Insurance Form Statement of Beneficiary for Accordia Life. - Form #216779

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Life Insurance Form Statement of Beneficiary for First Allmerica Financial Life Insurance Company - Form #230414

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Arizona State-Specific Policy Application for Reinstatement - Form #175136
Use the Application for Reinstatement to request a reinstatement of a lapsed policy. This version is for residents of Arizona.

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California State-Specific Policy Application for Reinstatement – Form #191681
Use the Application for Reinstatement to request a reinstatement of a lapsed policy. This version is for residents of California.

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Connecticut State-Specific Policy Application for Reinstatement – Form #191689
Use the Application for Reinstatement to request a reinstatement of a lapsed policy. This version is for residents of Connecticut.

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Delaware, District of Columbia and South Dakota Multi-State Policy Application for Reinstatement – Form #191692
Use the Application for Reinstatement to request a reinstatement of a lapsed policy. This version is for residents of Delaware, the District of Columbia or South Dakota.

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Florida State-Specific Policy Application for Reinstatement – Form #191684
Use the Application for Reinstatement to request a reinstatement of a lapsed policy. This version is for residents of Florida.

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New Jersey State-Specific Policy Application for Reinstatement – Form #191693
Use the Application for Reinstatement to request a reinstatement of a lapsed policy. This version is for residents of New Jersey.

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North Dakota State-Specific Policy Application for Reinstatement – Form #191687
Use the Application for Reinstatement to request a reinstatement of a lapsed policy. This version is for residents of North Dakota.

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Multi-State Policy Application for Reinstatement – Form #191694
Use the Application for Reinstatement to request a reinstatement of a lapsed policy. This version is for residents of states that do not require their own variation of the form.

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Wellness for Life® Program Rewards Qualification Form -  Form #16489
Used to stay qualified for the Wellness for Life® program. Complete the Wellness for Life® Program Qualification Form and have it signed by your doctor/health care provider at your regularly scheduled routine physical.

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