Get Change Request To

Filling out the Change Request To form is an essential step for managing your insurance policy effectively. This guide provides you with detailed, step-by-step instructions to help you complete the form online with ease.

Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Enter the company code and policy number in the designated fields. This ensures your request is processed accurately.
3. Indicate the premium/contribution amount you wish to change. Ensure this aligns with your financial preferences.
4. Provide the name of the insured or annuitant as requested. This name should match the official records.
5. If applicable, specify the loan repayment amount, noting that the minimum is $10. Indicate the repayment frequency by selecting from the options provided.
6. Choose the new premium billing mode: monthly, quarterly, semi-annual, or annual. If the selected mode is unavailable, the next available option will apply.
7. If you wish to discontinue the Automatic Bank Check (ABC) for premium and loan repayments, indicate this clearly in the specified section.
8. Fill in the withdrawal day you prefer for any automatic debits, selecting from the 1st to the 28th of each month.
9. Clarify how past due premiums will be managed, detailing how you will submit payments as necessary.
10. Complete your bank account information accurately, ensuring the details match what is on file at the bank. A voided check is highly recommended.
11. Read through the agreement section carefully. By signing, you authorize the company to debit your account according to your selections.
12. If applicable, both account owners should sign and date the form, ensuring all information is complete before submission.
13. Finally, save your changes, and download, print, or share the completed form as necessary.

Start filling out your Change Request To form online today!