Form POS 12 is a document that is used to record the financial information of a business. The form provides an overview of the company's revenue, expenses, and net income for a given period of time. It is important to ensure that the form is filled out accurately and completely in order to get a clear picture of the company's financial standing.
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