|
Forms with this icon  can be submitted directly to us via this web site. Forms with this icon are in PDF format. You will need Adobe Reader  to view and print the documents. These documents will need to be faxed to us at 515-247-2435 or sent to us via mail. BillingChange Billing Information
Use this form to change your billing address. Automatic Premium Payment Change
Use this form to change your bank or method of premium payment for automatic monthly withdrawals. PolicyOrder Duplicate Identification Card
Use this form to request a duplicate ID card. Change Policyholder Personal Information
Use this form to update your address. Request Coverage Information
Use this form to request information regarding your policy. Oregon Policyholder Estimate of Costs
If you are an Oregon policyholder with major medical coverage, please read this notice for detailed instructions to obtain an estimate of costs. Affidavit to Authorize American Republic Insurance Company to Pay Policy Benefits
Use this form to have a check reissued that was previously issued to the estate. Affidavit to Authorize American Republic Corp Insurance Company to Pay Policy Benefits
(Medicare Supplement Insurance)
Use this form to have a check reissued that was previously issued to the estate. Privacy Authorization Form - American Republic Insurance Company
Use this document to grant covered entity permission to release information to designated individuals. Privacy Authorization Form - American Republic Corp Insurance Company (Medicare Supplement Insurance)
Use this document to grant covered entity permission to release information to designated individuals. ClaimsLong Term Care Claim Form
Use this form to submit a claim regarding Long Term Care policies. Care Assist Claim Form
Use this form to submit a claim regarding Care Assist polices. PharmacyPrescription Drug Claim Form
Need to make a claim for a prescription drug? This is the form you need to submit to ExpressScripts, Inc. GeneralAsk for Company Information
Have general questions regarding our company? Submit a Question
Have a question or want to give us feedback? Life InsuranceLife Policy Beneficiary Change
Make changes to the beneficiary designation on your life insurance policy. Life Policy Absolute Assignment
Change the ownership on a life insurance policy. Cash Surrender Value Request
Cancel your life insurance policy with cash value and receive the cash surrender value. Partial Cash Surrender Value Request
Take a partial withdrawal from the cash value of your LifeSavings policy but maintain coverage with decreased death benefit. Policy Loan Agreement
Use this form to borrow from the cash value on a policy. Extended Term Insurance Request
Request to use cash value to extend length policy without paying any further premium payments. Termination of Term Life Insurance
Use this form to cancel term life insurance policy. Dividend Options
If dividends are earned, this form will change the way dividends are paid. Use this form to update name or address. Reduced Paid-Up Insurance Request
To use the cash value to reduce death benefit without any further premium payment. Proof of Death
This form is required when filing a Death Claim for a Life Insurance Policy. Used in conjunction with the W-9 form. W-9 Form
This form is required when filing a Death Claim for a Life Insurance Policy. Used in conjunction with the Proof of Death form.
|