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.
