In today's fast-paced world, navigating policy changes with insurance companies can sometimes feel like a daunting task. Among the plethora of forms is the POS 12 form, a critical document for those looking to adjust their policy details with the U.S. Financial Life Insurance Company. Situated in Syracuse, New York, this form serves as a conduit for policy owners to request changes ranging from basic personal information adjustments to more significant alterations like changing the policy's stated amount, adding or canceling riders or benefits, and even converting term policies. The process is designed to be straightforward, requiring policy owners to fill in essential details such as policy number, agent information, and specifics about the insured. The form underscores the importance of complete accuracy and disclosure, cautioning against any fraudulent submissions. Further enhancing its accessibility, the POS 12 form, complemented by reinstatement forms for certain requests, emphasizes the necessity for all accompanying documents to be filled out meticulously to avoid processing delays. With provisions for both policy owners and insurers, the document also navigates the legal intricacies in community property states, requiring signatures from both spouses to solidify the requested changes. A testament to the form's comprehensive nature is its detailed inclusion of contact information, vital for ensuring clear communication channels between the policyholder and the insurance provider. This introduction to the POS 12 form aims to demystify the process, providing a beacon for those aiming to amend their life insurance coverage, reflecting a commitment to flexibility, understanding, and protection.
| Question | Answer |
|---|---|
| Form Name | Form Pos 12 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | submits, New_York, formssoftware, facilitating |
P.O. Box 4763
Syracuse, New York
Phone: (800)
Fax: (315)
REQUESTFORPOLICYCHANGE
POLICYNUMBER: |
AGENT: |
|
|
POLICYOWNER: |
INSURED: |
|
|
POLICYOWNERADDRESS: |
HEIGHT: |
WEIGHT: |
DOB: |
SOCIALSECURITYNO:
HOMEPHONE:
WORKPHONE:
SELECTTHE DESIRED POLICYCHANGE TRANSACTION BELOW:
In order to prevent any delay in processing, please complete all required forms in their entirety,
including all doctor(s) information, complete address(es) and phone number(s).
Reinstatement forms can be found at www.usfli.com/policy owner service forms/reinstatement forms.
1. |
Change policy stated amount from |
|
|
|
|
|
|
to |
|
|
|
|
|
|
. |
||||||||
|
(A completed reinstatement form is required for increase requests.) |
|
|
|
|||||||||||||||||||
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||
2. |
Add Rider/Benefit: |
|
Child |
|
|
Additonal Insured Person |
|
Waiver |
|
Accidental Death |
|||||||||||||
|
(A completed reinstatement form is required for additions of any riders or waiver benefits.) |
||||||||||||||||||||||
3. |
Cancel Rider/Benefit: |
|
Child |
|
|
|
Additonal Insured Person |
|
|
Waiver |
|
|
Accidental Death |
||||||||||
|
|
|
|
|
|
|
|
||||||||||||||||
4. |
Remove or reduce policy rating. |
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
|
||||||
|
(A completed reinstatement form is required for rate or smoker class changes. For smoker |
||||||||||||||||||||||
|
class changes, please include a completed tobacco questionnaire that is available on our |
||||||||||||||||||||||
|
|
|
|
|
|
|
|
||||||||||||||||
5. |
Change Death Benefit Option to: |
|
|
|
|
Option A |
|
Option B |
|
|
|
|
|
|
|
||||||||
|
|
|
|
|
|
|
|
|
|
|
|
||||||||||||
6. Term
*COMMUNITYPROPERTYSTATES REQUIRE SIGNATURES OFBOTH SPOUSES*
Dated |
at |
|
||
|
|
|
City |
State |
|
|
|
|
|
|
Signature of Insured |
|
Signature of Owner if other than Insured |
|
Signature and Title of Assignee
Signature of Witness
FOR OFFICE USE ONLY
REQUEST APPROVED:
DATE
BY:
U.S. FINANCIAL LIFE INSURANCE COMPANY