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CUSTOMER FORMS

Form Name Form Description
AllState Accident-Disability Claim Form Use this form to file a claim for your AllState Accident Policy.
AllState Appeal Request Form Use this form to request an appeal of a denied claim.
AllState Cancer Claim Form Use this form to file a claim for your AllState Cancer Policy.
AllState Contunance of Disability Claim Form Use this form to continue receiving claims on your AllState Disability Policy.
AllState Critical Illness Claim Form Use this form to file a claim for your AllState Critical Illness Policy.
AllState Wellness Claim Form Use this form to file a claim for your AllState Disability Policy.
American Equity Life Customer Service Form Use this form to make changes to your address, name, or beneficiary for your American Equity Life insurance policy. 
American General Beneficiary Change Form Use this form to change your beneficiary for your American General Life insurance policy.
American General Customer Service Form Use this form to change your address or name on your American General Life insurance policy.
Americo Customer Service Form Use this form to make changes to your address, name, or beneficiary on your Americo Life insurance policy. ******If you choose to cash surrender your Life Insurance policy, please call 800-277-2300 to obtain a payroll deduction change form to stop the deduction for this policy.
Assurant Accident Claim Form Use this form to file a claim for your Assurant Accident Policy. 
Assurant Cancer Claim Form Use this form to file a claim for you Assurant Cancer Policy.
Assurant Supplemental Change Form Use this form to change your address or name on your Assurant supplemental insurance policy. This includes Accident, Cancer, and Short Term Disability policies.
Assurant Waiver of Premium Form Use this form to apply to have premiums paid while out of work. ***Note: This only can be used if the waiver of premium rider has been added to your policy.***
Conseco Address and Name Change Form Use this form to change your address or name for your Conseco Life insurance policy. 
Conseco Beneficiary Change Form Use this form to change your beneficiary for your Conseco Life insurance policy.
Conseco Duplicate Policy Request Form Use this form to request a duplicate policy or a certificate of insurance for your Conseco Life insurance policy. A certificate of insurance is a one page summary of your life insurance policy. 
TransAmerica Address Change Form Use this form to update your address for your TransAmerica/Life Investors Life insurance policy.
TransAmerica Beneficiary Change Form Use this form to change your beneficiary change on your TransAmerica/Life Investors Life insurance policy.
TransAmerica Name Change Form Use this form to change your name on your TransAmerica/Life Investors Life insurance policy.

instructions

  • After completing the appropriate form(s), please fax it (them) to State Securities Corp. at 850-385-6913. 
  • If you have any questions on completing the forms, please call State Securities Corp. at 800-277-2300.