Administrative forms

Instructions

  1. Fill out and sign the form
  2. Gather original supporting documents
  3. Send everything to the address indicated on the form

Important

  • Keep copies of all correspondence for at least 12 months.
  • Originals will not be returned.

Accirance product forms


Change of contract holder (PDF, 261 KB) Opens in a new window.

Use this form to make a change to the contract holder.

Important:

This form must be signed by both the current contract holder and the new contract holder. If you are requesting the change due to the current contract holder's death, please enclose a copy of the death certificate.


Beneficiary designation, revocation or addition (PDF, 131 KB) Opens in a new window.

Use this form to make a change to the contract's beneficiary or beneficiaries.

Important:

This form must be signed by the current beneficiary if they are designated as «irrevocable». If you are requesting the revocation of a beneficiary due to their death, please attach a copy of the death certificate.


Get Well Insurance product forms


Beneficiary designation, revocation or addition (PDF, 131 KB) Opens in a new window.

Use this form to make a change to the contract's beneficiary or beneficiaries.

Important:

This form must be signed by the current beneficiary if they are designated as «irrevocable». If you are requesting the revocation of a beneficiary due to their death, please attach a copy of the death certificate.


Change in smoker status (PDF, 265 KB) Opens in a new window.

Use this form to make a change to the insured's smoker status.

Important:

To qualify for non-smoker status, you will need to declare that you have not used any form of tobacco (cigarettes, cigars, cigarillos, pipe tobacco, marijuana, nicotine patches, nicotine gum or smoking cessation drugs) in the past 12 months.


50+ Life Insurance product forms


Beneficiary designation, revocation or addition (PDF, 131 KB) Opens in a new window.

Use this form to make a change to the contract's beneficiary or beneficiaries.

Important:

This form must be signed by the current beneficiary if they are designated as "irrevocable". If you are requesting the revocation of a beneficiary due to their death, please attach a copy of the death certificate.


Change in smoker status (PDF, 229 KB) Opens in a new window.

Use this form to make a change to the insured's smoker status.

Important:

To qualify for non-smoker status, you will need to declare that you have not used any form of tobacco (cigarettes, cigars, cigarillos, pipe tobacco, marijuana, nicotine patches, nicotine gum or smoking cessation drugs) in the past 12 months.