Service Forms

We'd like to help you with some basic aspects of policy management by means of downloadable, printable forms. To view or print them, you will need the Adobe Acrobat Reader, which is a free download. Get the Acrobat Reader here.

Once the file is open, you may print the form, fill in the information, sign it, and return it to Assurity at the address shown below. Forms are available for the following transactions, with more becoming available as this section expands:

• Use this form to notify us of a change of name.
• Use this form to notify us of a change of address.
• Use this form to initiate monthly premium payments being withdrawn automatically through your bank, or if you change banks.
• Use this form to notify us of the death of an Insured, so that we may send you the necessary forms for completion.

(For notification of disability, please call 1-800-869-0355.)