Policy owner service forms

 Assignment of policy as collateral security

Electronic payment authorization

Policy change form

  • Change policy amount
  • Add/cancel rider/benefit
  • Remove/reduce policy rating
  • Change death benefit option
  • Term re-entry


W-9 request for tax payer ID

Reinstatement forms

Power of attorney customer identification

 Policy owner service request

  • Name/address change/correction
  • Change payment mode
  • Change planned premium
  • Loan/surrender (full or partial)
  • Tax withholding
  • Lost policy/duplicate policy

Beneficiary statement

Beneficiary change

Ownership change

Agent of record change form

Illustration request form

Request for term conversion

Agent form

First Notice Of Death


Contact us

For questions or comments & policy inquiry:

U.S. Financial Life Insurance Company 
P.O. Box 1419 
Charlotte NC 28201-1419

(800) 959-3894

(855) 784-1586



The receipt of 5498 or 1099 tax information - If you were 70 1/2 years at the end of 2017 and withdrawn from your annuities in 2018 we will be sending you a 5498 or a 1099 to file with the IRS.
Please contact us if you have not received your tax information.


AXA S.A. is a French holding company for a group of international insurance and financial services companies, including AXA Equitable Financial Services, LLC. (AEFS). "AXA" is the brand name of AEFS and its family of companies, including AXA Equitable Life Insurance Company (AXA Equitable) (NY, NY), MONY Life Insurance Company of America (AZ stock company, admin. office: Jersey City, NJ) (MONY America), and AXA Distributors, LLC. All group insurance products are issued either by AXA Equitable or MONY America, which have sole responsibility for their insurance and claims-paying obligations. Some products are not available in all states.


Image used for Space here