Focused on What Matters Most Provider Agents Forms Insured Home About IAC COVID 19 Products Policy Owner Services Contact Us All Forms Download Page Medicare Supplement Forms Request for Service Forms include: Ordering a duplicate policy Ordering duplicate ID Card Name Changes Address Changes Policy Cancellation Telephone Number Changes Payment Method Change Request to Reduce/Increase Benefits Request for Service Form - ALL States: Download the form Request for Service Form - MN: Download the form Request for Service Form - WI: Download the form Request for Bank Draft Payment: Download the form Life Insurance Forms Request for Service Forms include: Ordering a duplicate policy Name Changes Address Changes Change of Ownership Full Surrender Telephone Number Changes Request to Reduce Coverage Payment Method Change Cancellation of Riders Request for Service Form - LIFE ONLY: Download the form Beneficiary Change Request: Download the form Distribution of Proceeds for Minor Beneficiary: Download the form Electronic Direct Deposit Application for Annuity Payments: Download the form Life Insurance Reinstatement Application - NE ONLY: Download the form Life Insurance Reinstatement Application - OH ONLY: Download the form Life Insurance Reinstatement Application-AR, CNMI, CO, GU, HI, IA, IL, IN, KS, KY, MI, NV, OK, TX, WA, WI, WY ONLY: Download the form Life Insurance Reinstatement Application-MN ONLY: Download the form Release of Assignment Request-LIFE ONLY: Download the form Request for Bank Draft Payment: Download the form Ordinary Life Insurance Reinstatement Application-MO, FSM, RMI, Palau ONLY: Download the form Universal Life Insurance Reinstatement Application-MO, FSM, RMI, Palau ONLY: Download the form Universal Life Reinstatement Application - AL ONLY: Download the form Universal Life Request for Partial Surrender or Policy Loan Form: Download the form Pacific Group Life Forms Child with Disability Eligibility Form - FSM: Download the form Claims Processing Report: Download the form Distribution of Proceeds for Minor Beneficiary: Download the form Enrollment Form - CNMI: Download the form Enrollment Form - FSM: Download the form Enrollment Form - RMI: Download the form Evidence of Insurability - CNMI: Download the form Evidence of Insurability - FSM: Download the form Evidence of Insurability-Parent - RMI: Download the form Evidence of Insurability - Parent - Spouse Child - RMI: Download the form Release of Assignment - CNMI: Download the form Request for Refund Form - CNMI: Download the form Request for Refund Form - FSM, RMI: Download the form Waiver of Premium Election Form - RMI: Download the form MEDICARE SUPPLEMENT PHONE (888) 524-3629 FAX (385) 207-7884 LIFE INSURANCE PHONE (800) 821-5434 FAX (866) 680-5652 THIRD PARTY ADMIN PHONE (405) 285-0838 FAX (405) 285-0836 © 2021 Copyright Individual Assurance Company, Life, Health & Accident and its Subsidiaries and Affiliates A- A A+ One Western Plaza, 5500 N. Western, Suite 200, Oklahoma City, Oklahoma 73118 To Top