Service Request

“The goal as a company is to have customer service that is not just the best but legendary.”

—Sam Walton

You're Never Alone—Real Support When It Matters Most

Financial Service Forms

Online Financial forms at your fingertips

What Would You Like to Do?

Change mailing address, beneficiary or owner information

Change a beneficiary designation – Complete the Beneficiary Change/Designation section on Page 1 and the Signature section on Page 2. Qualifying witnesses include any adult other than the insured, designated beneficiary or policyowner.

Policy Service Form (All states except CA)

Policy Service Form (CA)

Change mailing address – Complete the Change of Mailing Address section on Page 1 and the Signature section on Page 2.

Policy Service Form (All states except CA)

Policy Service Form (CA)

Change or correct name of insured or owner – Complete the Name Change/Correction and Signature sections on Page 2 along with the included W-9 for the individual whose name is being changed/corrected.

Policy Service Form with W-9 Taxpayer ID Certification (All states except CA)

Policy Service Form with W-9 Taxpayer ID Certification (CA)

Change an ownership designation – Complete the Ownership Designation section on Page 1 and Signature sections on Page 2 along with the included W-9 for the new owner(s).

Policy Service Form with W-9 Taxpayer ID Certification (All states except CA)

Policy Service Form with W-9 Taxpayer ID Certification (CA)

Request a Loan, partial withdrawal, surrender, or distribution

Request a loan, partial withdrawal or surrender on your LIFE insurance policy:

Policy Service Form with W-9 Taxpayer ID Certification (All states except CA)

Policy Service Form with W-9 Taxpayer ID Certification (CA) - Complete the service form indicating the desired transaction. The policyowner must sign and date the service form and the included W-9.

Electronic Funds Transfer - Use to request deposit directly into savings or checking account.

Request a partial withdrawal, distribution or surrender from your ANNUITY contract:

Annuity Service Form with W-9 Taxpayer ID Certification (All states except ME)

Annuity Service Form with W-9 Taxpayer ID Certification (ME) - Complete Page 2 and the Signature section on Page 3 along with the W-9 for policyowner requesting the transaction.

Electronic Funds Transfer - Use to request deposit directly into savings or checking account

Request annuitization/settlement option on your ANNUITY contract:

Annuity Service Form with W-9 Taxpayer ID Certification (All states except ME)

Annuity Service Form with W-9 Taxpayer ID Certification (ME) - Complete Page 1 and the Signature section on Page 3 along with a W-9 for policyowner requesting annuitization/settlement option.

Electronic Funds Transfer - Use to request deposit directly into savings or checking account.

Change premium payment method to EFT or update banking information

Pre-Authorized Withdrawal Agreement – Complete, sign, and date the form.

Remove a rider Complete Change Base Policy section on Page 1 indicating which rider is to be removed and complete the Signature section on Page 2.

Policy Change Form (All states except CA)

Policy Change Form (CA)

Add a child to an existing Children's Term Rider – Complete the Addition of Child to Existing Children's Term Rider and Signature sections on Page 2.

Policy Service Form (All states except CA)

Policy Change Form (CA)

Review the Life Insurance Buyer’s Guide – Learn how to find a policy that meets your needs and fits your budget, decide how much insurance you need and make an informed decision when buying a policy.

Life Insurance Buyer's Guide (All states except ME, NJ)

Life Insurance Buyer's Guide (ME)Life Insurance Buyer's Guide (NJ)

Review the Annuity Buyer’s Guide – Understand the differences among various annuities so you can choose the kind that best fits your needs.

Buyer's Guide to Fixed Deferred Annuities (All states except MT, NM)

Buyer's Guide to Fixed Deferred Annuities (MT, NM)

Report a Life, Annuity or Disability ClaimLife Claims Process - Download the necessary forms, find contact information and learn what to expect during the process.

Signed Forms

Return completed, signed forms to Ai Merchantry.

Mail:
Financial / Policy Services
Americas insurance Merchantry™
207 W Millbrook Road, Suite 200

Raleigh, NC 27609

Fax:
1-844-626-2246

Email:
[email protected]

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