When the time comes to navigate the complexities of managing life insurance policy funds, individuals often encounter the necessity of understanding various forms and documents, one of which is the Loan Request Repayment form. This particular document serves multiple purposes, primarily facilitating policyholders in borrowing against the cash value of their life insurance policies or repaying existing loans. Drafted by reputable companies such as Monumental Life Insurance Company, Transamerica Life Insurance Company, and Western Reserve Life Assurance Co. of Ohio, and handled through their administrative office in Cedar Rapids, Iowa, this form requires careful attention to detail. Policyholders are asked to provide essential information including policy or certificate numbers, contact details, and the specifics of the loan request or repayment plan. The form is meticulously designed to offer choices ranging from obtaining a cash loan based on the policy's current value to adding options like the Automatic Premium Loan (APL), which prevents a policy from lapsing by automatically applying a loan against the cash value to pay premiums when due. This flexibility underscores the broader purpose of the form—to ensure policyholders can manage their policies in a way that aligns with their financial needs and circumstances. By signing this document, policyholders, along with any assignees or spouses (if applicable), acknowledge their understanding and agreement to the terms of the loan or repayment, making it a pivotal step in the ongoing management of one’s life insurance policy.
| Question | Answer |
|---|---|
| Form Name | Loan Request Repayment Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | Assignee, YR, forms, Repayment |
Monumental Life Insurance Company
Transamerica Life Insurance Company Western Reserve Life Assurance Co. of Ohio Administrative Office located at:
4333 Edgewood Road N.E., Cedar Rapids, IA
FAX
Loan Request/Repayment
Policy/certificate number (s)___________________________ |
Insured/Annuitant__________________________ |
Owner____________________________________________ |
Phone Number_____________________________ |
Fill out all required information in sections 1 and 2 and sign below.
1.Loan Request
Select one:
_____A cash loan for $ ___________________ (In addition to present loan, if any).
_____A cash loan of accumulated interest only (Limited to single premium universal life).
_____A cash loan for the largest amount available.
_____A loan to pay premiums on policy # __________________, due date ______/______/ _____.
MO DAY YR
_____Add the Automatic Premium Loan (APL) option to my policy.
2.Loan Repayment
Increase the amount I am billed each regular period (monthly, quarterly, etc.) by $________________
(Minimum $10.00)
Insured /Annuitant____________________________________ |
____________________________________ |
||
Signature |
Date Signed |
Social Security Number |
Date of Birth |
Owner_____________________________________________ |
____________________________________ |
||
Signature |
Date Signed |
Social Security Number |
Date of Birth |
Assignee____________________________________________
Signature Title Date Signed
Spouse__________________________________________________
Signature- (if none, indicate, NONE)
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