Genworth’s life insurance forms will assist you with making changes to your index universal life, guarantee universal life, term life insurance and whole life insurance accounts. These forms will help you conduct life insurance authorizations, requests, name/address change, naming a beneficiary and other updates.
Address, name and third party changes
Submit address or name changes for yourself or other parties on your policy, or to add, change or delete a third party listed on your policy to receive billing notices (for use with Life Insurance policies only).
Agent Change Request
Use to request a change to the Servicing agent on your policy(ies).
Allocation and Transfer Change Form for Index UL Products
Information must be completed and received by the 1st of the month to process allocation changes on the 15th of the month. Available for Index UL products only.
Authorization for third party to receive information
Use when authorizing a third party to receive information about your policy. The authorized person will be required to provide appropriate security verification for any phone requests for information.
Certification of trustee powers
Required to show signing authority for contracts owned by a Trust for Genworth Life and Annuity Insurance Company, Genworth Life Insurance Company and Genworth Life Insurance Company of New York.
Collateral Assignment
Use when assigning policy proceeds to cover a loan (i.e. bank loan)
Declaration of attorney-in-fact (for use with Life Insurance and Annuities only)
Required to show signing authority for an Attorney-in-Fact acting under a Power of Attorney for the policy or contract owner. For use with Life Insurance and Annuities only.
Duplicate contract authorization
Request a duplicate copy of a lost or destroyed policy or contract.
Electronic funds transfer (EFT) - Premium Renewal
Request automatic withdrawals from your bank account to pay premiums on life or long term care insurance policies, or to update bank account information for policies already drafting premiums.
Beneficiary Change Form
Request beneficiary changes on any life insurance policy. If change of ownership and beneficiary is needed please use the Ownership and beneficiary designation request form applicable for your state (listed below).
Index Universal Life withdrawal, loan or surrender request
Used to request the following transactions on your Index Universal Life insurance policy: one-time withdrawal or loan, recurring withdrawals or loans, loan type switching, or full surrender.
Ownership and beneficiary designation request form (Use this form for policies delivered in CA, CT, DE, DC, FL, ND and SD)
Request owner and beneficiary changes on any life insurance policy.
Ownership and beneficiary designation request form (Use this form for policies delivered in all states except CA, CT, DE, DC, FL, NY, ND and SD)
Request owner and beneficiary changes on any life insurance policy.
Ownership and beneficiary designation request form (Use this form for policies delivered in NY)
Request owner and beneficiary changes on any life insurance policy.
Minnesota Questionnaire
A completed supplement is required if a beneficiary change request is received AND the policy was issued within the past 4 years AND the new proposed beneficiary is anyone other than a family member AND any of the following are true:
- The existing owner is a MN resident
- The new beneficiary is a MN resident (including the viatical company is a resident company)
- Any assignee is a MN resident or company
- The policy was issued in MN
Release of Collateral Assignment
Use when assignment of policy is relinquished or released
Surrender Authorization
Use to request a full surrender of a life insurance policy.
Loan Authorization for Life Insurance
Use to request a loan on your life insurance policy.
Withdrawal Authorization for Life Insurance
Use to request a withdrawal on your life insurance policy.
Linked Benefits - Total Living Coverage (TLC) Sample Policy (California Only)
This sample copy of Genworth Life Insurance Company's Universal Life Insurance policy is being provided for informational purposes only. THIS SAMPLE POLICY IS NEITHER A CONTRACT OF INSURANCE NOR AN OFFER TO CONTRACT.
United States
