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    U.S. Financial Life Insurance Company

    A Heritage Life Company

    Customer forms
    Contact information

    1.  Assignment of policy as collateral security

    2.  Electronic payment authorization

    3.  Policy change

    4.  Term re-entry

    5.  Questionnaires

    6.  W-9 request for tax payer ID

    7.  Reinstatement forms

    8.  HIPPA form

    9.  Financial supplement

    10.  Designation Identification Form

     

    11.  Policy owner service request

         11a.  Address change

         11b.  Name or date of birth change

         11c.  Premium and mode change

         11d.  Loan request

         11e.  Full or partial surrender

    12.  Beneficiary statement

    13.  ACH authorization for direct deposit

    14.  Beneficiary change

    15.  Rights change

    16.  Agent of record change

    17. First notice of death

    18.  Illustration request


    19.  Request for term policy conversion

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    Heritage Life Insurance Company

    227 West Monroe Street, Suite 3775

    Chicago, IL 60606

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