Life Insurance Forms

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Send the form to:

Mailing Address:
Life Investors Insurance Company of America
Attn: Customer Service
4333 Edgewood Rd NE
Cedar Rapids, IA 52499-0001


Address Change

Change your address of record. Requires policyowner's signature.

Annuity Policy or Annuity Rider Withdrawal

Request to make a withdrawal from your annuity policy. Requires policyowner's signature.

Beneficiary Change

Change the beneficiary(s) on your policy. Requires policyowner's signature. For definition of types of beneficiaries refer to glossary.

Coverage Changes/Decreases/Removals

Request to decrease or remove coverage from your policy. Requires policyowner's signature.

Coverage Changes/Increases/Rating and Class

Request to increase coverage or change rating, class or death benefit option on your policy. Requires policyowner's signature.

Dividend Request

Request dividend withdrawal or changes to your policy. Requires policyowner's signature.

Index Universal Life Transaction Form

Premium allocation change or transfer dollars from basic interest to index account.

First Notification of Claims First notification of a claim. Complete First Notification of Claim template and click on submit.

Full Surrender

Request to surrender your policy. Requires policyowner's signature.

Loan Request/Repayment

Request a loan or loan payment on your policy. Requires policyowner's signature.

Military Information

Form to update personal information during active duty.

Name Change

Request a legal change to your name on our records. Requires policyowner's signature.

Ownership Change

Change the owner on your policy. Requires current policyowner's signature and new policyowner's signature.

Payroll Deduction

Authorization form for employee or patron to establish or change premium payments paid via a deduction from payroll.

Partial Withdrawal

Request a partial withdrawal from your policy. Requires policyowner's signature.

Pre-Authorized Payment Plan

Set up automatic bank drafts from savings/ checking account for your policy. Please attach a voided check. For definition of Pre-Authorized Payment see glossary.

Reduced Paid-up Extended Term Insurance

Request policy to be put on Reduced Paid-Up or Extended Term Insurance. Requires policyowner's signature.

Request for RDF/PDF/TPA/GRA Withdrawal/Surrender

Specify which fund the money should be drawn from. Requires policyowner's signature.