National Benefit LifeInsurance Forms Policy Change FormsChange of Ownership
Click to print form Change of Ownership Form How is this used? To correct, change or name a new owner or joint owner. Signature Requirements Current owner and new owner should sign form. Mail Form to: National Benefit Life Insurance Company Attn: Policy Owner Services One Court Square Long Island City, NY 11120-0001 Change of Beneficiary
Click to print form Change of Beneficiary Form How is this used? Change the beneficiary of your policy with this easy to use form. Signature Requirements Policy owner must sign form *If there is an irrevocable beneficiary their signature is also required Mail Form to: National Benefit Life Insurance Company Attn: Policy Owner Services One Court Square Long Island City, NY 11120-0001 Affidavit of Small Estate - Owner ISACH08
Click to print form Affidavit of Small Estate - Owner ISACH08 How is this used? Only complete if current owner is deceased and did not leave a probate estate. Signature Requirements Small Estate Administrator should sign form and provide death certificate of previous owner. Mail Form to: National Benefit Life Insurance Company Attn: Policy Owner Services One Court Square Long Island City, NY 11120-0001 Change of Name Statement
Click to print form Change of Name Statement How is this used? To correct or change the name of owner or insured Signature Requirements Current owner should sign form. Mail Form to: National Benefit Life Insurance Company Attn: Policy Owner Services One Court Square Long Island City, NY 11120-0001 Change of Address - ISACH07
Click to print form Change of Address - ISACH07 How is this used? To correct or change current address on file. Signature Requirements Current owner should sign form. Mail Form to: National Benefit Life Insurance Company Attn: Policy Owner Services One Court Square Long Island City, NY 11120-0001 Reinstatement Forms - NYL-87 B and Und. Rein. 001.11/91 Life
Click to print form New York Reinstatement Form - NYL-87 B Und. Rein. 001.11/91 Life - All states *except* New York How is this used? Complete to reinstate lapsed policy. Signature Requirements Current owner and insured should sign form. Mail Form to: National Benefit Life Insurance Company Attn: Policy Owner Services One Court Square Long Island City, NY 11120-0001 Duplicate Policy - NO Form required
Duplicate Policy - No Form required How do I request a duplicate policy? Write to us at the address below to request a copy of your contract. Signature Requirements Policy owner must sign the written request. Mail Request to: National Benefit Life Insurance Company Attn: Policy Owner Services One Court Square Long Island City, NY 11120-0001 Pre-Authorized Check Plan Request (PAC) - NYL-21
Click to print form and Instruction Page Pre-Authorized Check Plan Request (PAC) - NYL-21 EXCLUDES Universal Life Policies and Annuity Contracts How is this used? For automatic drafting of Life Insurance premium from checking account. Signature Requirements Account holder must sign. Mail Form to: National Benefit Life Insurance Company Attn: Policy Owner Services One Court Square Long Island City, NY 11120-0001 Pre-Authorized Check Plan - CHANGE OF BANK (PAC) - NYL-21
Click to print form and Instruction Page Pre-Authorized Check Plan - CHANGE OF BANK (PAC) - NYL-21 EXCLUDES Universal Life Policies and Annuity Contracts How is this used? To change a bank or account number from previously set-up check plan. Signature Requirements Account holder must sign. Mail Form to: National Benefit Life Insurance Company Attn: Policy Owner Services One Court Square Long Island City, NY 11120-0001 Electronic Payment Request (EP)
Electronic Payment Request (EP) - No FORM required How is this used? Your insurance premium can be paid electronically using your bank’s online bill pay service 24 hrs a day, 7 days a week. Signature Requirements Visit your banks website for details on how to set up electronic payments. Please include your policy # including leading zeros when setting up your electronic payment. Mail Form to: National Benefit Life Insurance Company Attn: Policy Owner Services One Court Square Long Island City, NY 11120-0001 Insurance Claim Forms
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