MENU English Español English myHomesteaders® Login Search Policy Owner Forms The following Homesteaders Life Company insurance service forms are available in PDF format. Please select the appropriate form, print and complete. The form may be mailed, faxed or emailed to our office. Our mailing address is PO Box 1756, Des Moines, IA 50306-1756. If emailing, please send to service@homesteaderslife.com. Our fax number is 515-440-7695. If you have any questions regarding the completion of these forms, please contact our customer service team at 800-477-3633. Our business hours are 8 a.m. to 4 p.m. Monday through Friday, and 8 a.m. to 1 p.m. Friday (Central time). CUSTOMER SERVICE REQUEST Use this form for policy change requests including nonforfeiture, cash surrender and plan/benefit changes. Please note that this form requires a witness signature and the policy owner’s Social Security or Tax ID where indicated. English Spanish REQUEST FOR DUPLICATE POLICY This form is used to request a duplicate copy of a policy in the event the original is lost or destroyed. English Spanish REQUEST FOR AUTOMATIC PAYMENT PLAN This form is used to authorize recurring automatic premium withdrawals from a checking/savings account. English Spanish APPLICATION FOR REINSTATEMENT This form may be required to reinstate a lapsed or terminated policy. English Spanish REINSTATEMENT BY REDATE This form is required to reinstate a policy by deferring past-due premiums. Certain restrictions apply to this method of reinstatement. English Spanish TRANSFER OF OWNERSHIP This form is required to transfer ownership rights under a Life Insurance or Annuity contract. English Spanish NAME CHANGE This form is required to change the legal name of an insured or owner in the event of marriage/divorce. English Spanish BENEFICIARY CHANGE This form is required to change beneficiary designation on the insurance policy. English Spanish ADDRESS/PHONE CHANGE Use this form to change the address or phone number for the insured or policy owner. We will also accept these changes from the policy owner by phone. English Spanish CHILD/GRANDCHILD RIDER APPLICATION This form is required to add additional children or grandchildren after a Child/Grandchild rider has been issued with the primary coverage insurance policy. search Type or Select State Select a state Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Illinois Indiana Iowa Kansas Kentucky Louisiana Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico North Carolina North Dakota Ohio Oklahoma Oregon Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia West Virginia Wisconsin Wyoming State Name State Name State Name State Name State Name State Name Select a state ADD-ON RIDER This form is used to add a single premium rider to an existing Homesteaders policy. The minimum premium requirement for the rider is $100. If the policy is funding a prearranged funeral agreement, a representative of the assigned funeral home must also sign the form before submitting to Homesteaders. A copy of the completed form should be retained by the policy owner and, if applicable, the associated funeral home. English Spanish myStore Terms of Use Privacy Policy myHomesteaders® Login For Affiliated Funeral Homes and Agents Find Account Executive © 2021 Homesteaders Life Company. All Rights Reserved. Life insurance and annuity products are issued by Homesteaders Life Company. Products are subject to state availability. Any information regarding Homesteaders Life Company's products is intended solely for licensed insurance and funeral professionals. Texas consumers visit www.prepaidfunerals.texas.gov for more information. DO NOT SELL MY PERSONAL INFORMATION Please visit www.homesteaderslife.com/covid-19-coronavirus-information for information about coronavirus (COVID-19). Site Map