Help

Life Insurance Forms

Change of Beneficiary Form        Form # 15029
Aviva Life and Annuity Company
Use the change of beneficiary form to change a primary or contingent beneficiary designation.

  Download PDF (44 KB)

Change of Beneficiary Form        Form # BL-088
Aviva Life and Annuity Company of New York
Use the change of beneficiary form to change a primary or contingent beneficiary designation.

  Download PDF (45 KB)

Change of Name or Address Form        Form # 15030
Aviva Life and Annuity Company
Used by policy owners to notify us in the event of a legal name change or to request a change to the current address on file.

  Download PDF (40 KB)

Change of Name or Address Form        Form # BL-089
Aviva Life and Annuity Company of New York
Used by policy owners to notify us in the event of a legal name change or to request a change to the current address on file.

  Download PDF (42 KB)

Change of Ownership Form        Form # 15028
Aviva Life and Annuity Company
Use this form to transfer the ownership of your policy.

  Download PDF (42 KB)

Change of Ownership Form        Form # BL-087
Aviva Life and Annuity Company of New York
Use this form to transfer the ownership of your policy.

  Download PDF (49 KB)

Policy Loan Request        Form # 15035
Aviva Life and Annuity Company
Used by policy owners to request a loan from their life insurance policy.

  Download PDF (38 KB)

Policy Loan Request Form        Form # BL-093
Aviva Life and Annuity Company of New York
Used by policy owners to request a loan from their life insurance policy.

  Download PDF (43 KB)

Bank Authorization Form        Form # 15036
Aviva Life and Annuity Company
To have your premium payments automatically deducted from your checking account, submit this form and a void check or Specification Sheet from your account. Please contact the Home Office at least five days prior to your draft date for any changes to an existing Pre-Authorized Check agreement.

  Download PDF (41 KB)

Pre-Authorized Check Authorization Form        Form # BL-094
Aviva Life and Annuity Company of New York
To have your premium payments automatically deducted from your checking account, submit this form and a void check or Specification Sheet from your account. Please contact the Home Office at least five days prior to your draft date for any changes to an existing Pre-Authorized Check agreement.

  Download PDF (45 KB)

Request for Co-Ownership        Form # 16283
Aviva Life and Annuity Company
This form is to be utilized any time there will be more than one owner.

  Download PDF (24 KB)

Trust Verification Form        Form # 16541
Aviva Life and Annuity Company and former American Investors Life Insurance Company, Inc.
Used by policy owners, in lieu of the complete copy of the trust, to certify the name, date and trustees of their trust.

  Download PDF (25 KB)

Trust Verification        Form # 1067NY
Aviva Life and Annuity Company of New York
Used by policy owners, in lieu of the complete copy of the trust, to certify the name, date and trustees of their trust.

  Download PDF (26 KB)

W-9 Taxpayer ID Form        Form # 9393
Aviva Life and Annuity Company, Aviva Life and Annuity Company of New York, and former American Investors Life Insurance Company, Inc.
Used by policy owners to certify their TID# of SS# is correct for the purpose of proper tax reporting.

  Download PDF (37KB)

Wellness for Life Program Qualification Form        Form # 16489
Aviva Life and Annuity Company
Used to stay qualified for the Wellness for Life program. Complete the Wellness for Life Program Qualification Form and have it signed by your doctor/health care provider at your regularly scheduled routine physical.

  Download PDF (100 KB)

Back to top

Contact Aviva

If you need help or have questions about your account statement, please contact us.

Or call toll-free at 1 800 800 9882

Find a local agent

Your independent local Aviva agent can help you with any questions you may have.

Or call toll-free at 1 800 800 9882