Life Insurance Forms

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- Annuities ��紫ý offers a variety of annuities designed to help grow, protect, and manage retirement savings turning it into steady, reliable lifetime income based on your personal preferences and goals.
- Life Insurance Life insurance is most commonly used to help protect your family from any financial effects of your and/or your spouse's death. Protect your family's financial well-being with life insurance, which can pay a death benefit to help replace a lifetime of your loved one's lost earning potential.
- For Institutions Whether you’re looking for a de-risking strategy for your company’s pension plan, want to provide financial security to your retirees, or looking for a strong investing partner, ��紫ý has the solutions and experience to help you succeed.
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- About Us Whether you’re protecting your loved ones or growing your assets, you’re highly invested in your financial future. And so are we. When you purchase life and retirement insurance, you’re buying a promise. A promise that today, tomorrow or ten years from now, we’ll be there. For nearly 160 years, we’ve fulfilled that promise. Our clients trust ��紫ý to protect what matters most to them—their families, their businesses, their futures.

Life Insurance Forms

Please select a topic from the PL list below.

��紫ý Insurance Forms

Change Policy Information

This form is used to request an address change on a life insurance or fixed annuity policy.

This booklet is used for ownership, beneficiary, or name changes and includes additional forms that may be needed for an ownership change.

Change Authorizations

This form may be used for a life insurance or fixed annuity policy to: authorize an interested party, request and receive policy information, remove an interested party, or stop/start duplicate mailings to an interested party.

This form is used to authorize the Policyowner to make telephone or electronic requests that are available on the policy, or to authorize a party other than the policyowner to make telephone or electronic requests. In the state of WA, if another party is appointed, a witness's signature is required.

Take Money Out of the Policy

This form is used to request a loan on a life insurance policy.

This form is used to surrender/cancel an existing life insurance or annuity policy.

This form can be used to request withdrawals of cash value and dividends and surrender paid-up additional insurance on a life insurance or fixed annuity policy.

Make Billing Changes

This form is used to request changes to billing and premium information on in-force life insurance policies.

This form is used to establish and change EFT requests for premium payments on life insurance & fixed annuity policies and policy loan repayments on life insurance policies only.

Make an Investment Change

This form is used to allocate payments, rebalance and/or transfer investment options using the variable transfer services available on your variable life insurance policy.

Used for PDP IUL product to request one-time transfers, payment transfers, Scheduled Indexed Transfers, or segment maturity reallocations.

Used for PDX & PDX 2 IUL products to request one-time transfers, payment transfers, Scheduled Indexed Transfers, or segment maturity reallocations.

Used for Horizon IUL, Horizon ECV IUL, Horizon SIUL, and Horizon IUL 2 to request one-time transfers, payment transfers, scheduled indexed transfers or segment maturity reallocations.

Used for PIA & PIA2 IUL products to request one-time transfers, payment transfers, Scheduled Indexed Transfers, or segment maturity reallocations.

Used for PIA 3, PIA 4, PIA 5 & PIA 6 IUL products to request one-time transfers, payment transfers, Scheduled Indexed Transfers, or segment maturity reallocations.

Used for IPEP, IPEP2, & IPEP3 IUL products to request one-time transfers, payment transfers, Scheduled Indexed Transfers, or segment maturity reallocations.

Used to for PIP LT & PIP LT 2 IUL products request one-time transfers, payment transfers, Scheduled Indexed Transfers, or segment maturity reallocations.

Used for PRIME & PRIME 2 IUL products to request one-time transfers, payment transfers, Scheduled Indexed Transfers, or segment maturity reallocations.

Used for Trident IUL product to request one-time transfers, payment transfers, Scheduled Indexed Transfers, or segment maturity reallocations.

Used for PIA Pro & PIA Pro 2 IUL products to request one-time transfers, payment transfers, Scheduled Indexed Transfers, or segment maturity reallocations.

Request Summary of Your Policy

This form is used to request a Certificate of Insurance or a duplicate policy on life insurance or fixed annuity policies.

Request a Duplicate Copy of Your Policy

This form is used to request a Certificate of Insurance or a duplicate policy on life insurance or fixed annuity policies.

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Please select a topic from the PL Promise Product list below.

PL Promise Product Forms

Change Policy Account Information (For PL Promise Products Only)

This form is used to request an address change on a life insurance policy.

This form is used for beneficiary changes.

This form is used for name changes.

This form is used for ownership changes.

This booklet used to request a variety of changes to an in force life insurance policy.

This form is used for reinstatement of a Child Rider on a lapsed policy.

This form is used for reinstatement of a lapsed policy.

This form is used when the policy owner or beneficiary is a trust.

Billing Payments (For PL Promise Products Only)

This form is used for billing and premium changes.

This form is used to establish and change EFT requests for premium payment.

This form is used to release a collateral assignment when a debt has been repaid on a collaterally assigned policy. A policy will remain collaterally assigned until this form is completed and returned to PL.

Change requests (For PL Promise Products Only)

This form is used for policy owned by business entities and other organization, or for other ownership arrangements to notify PL who is authorized to sign on behalf of the Policy Owners when exercising the policy's ownership rights

This form is used to request a Certificate of Insurance or a duplicate policy on insurance policies.

This form is used to assign a policy as collateral security for an obligation owed to a bank, company or individual. It’s execution transfers certain contractual rights from the policy owner to the assignee

This form may be used to authorize an interested party, request and receive policy information, remove an interested party to stop/start duplicate mailing to an interested party.

This form is used to replace any existing Producer/Agency that services the policy/contract with the New Producer/Agency named

Withdrawal Requests (For PL Promise Products Only)

This form is used for surrendering policies.

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