HOME WHO WHAT HOW TEAM CONTACT NEWS More U.S. Financial Life Insurance Company A Heritage Life Company Customer forms Agent forms Contact information Policy owner service forms Assignment of policy as collateral security Electronic payment authorization Policy owner service request Name / address change / correction Change payment mode Policy change form Change policy amount Add / cancel rider / benefit Remove / reduce policy rating Change planned premium Loan / surrender (full or partial) Tax withholding Lost policy / duplicate policy Change death benefit option Term re-entry Questionnaires W-9 request for tax payer ID Reinstatement forms Power of attorney customer identification Beneficiary statement Beneficiary change Ownership change Agent of record change form Illustration request form Request for term conversion Heritage Life Insurance Company 227 West Monroe Street, Suite 3775 Chicago, IL 60606 HOME WHO WHAT HOW TEAM CONTACT NEWS ACCESSIBILITY ABOUT US Copyright 2021 © Heritage Life Insurance Company. All Rights Reserved

HOME WHO WHAT HOW TEAM CONTACT NEWS More Questionnaires Alcohol Usage Cancer Diabetes Driving Violations Drug Usage Heart Disorder Stroke Tobacco Usage Contact us For questions or comments & policy inquiry: Mail: U.S. Financial Life Insurance Company P.O. Box 3016 Monroe, WI 53566-3016 Telephone: (800) 959-3894 Fax: (855) 784-1586 Email: usfli@heritageli.com Attention Illinois residents: Cook, Kane, Lake, and McHenry counties, in Illinois, have been declared state disaster areas. Heritage is offering temporary relief to affected policyholders. Please send all correspondence (letters or policy forms) to our post-office box in Monroe, WI. Please note that mail sent to our parent company's Chicago address will be delayed as it will need be forwarded to our processing team. To track your shipment, the US Postal Services' Priority or Express Mail is recommended as other shipping carriers do not deliver to post-office boxes. Premium payments should be sent using the self-addressed envelope included with your statement. Back to Forms Heritage Life Insurance Company 227 West Monroe Street, Suite 3775 Chicago, IL 60606 HOME WHO WHAT HOW TEAM CONTACT NEWS ACCESSIBILITY ABOUT US Copyright 2021 © Heritage Life Insurance Company. All Rights Reserved