Client Forms

Agent Assignment Form

- Please open the attached Agent Assignment Form and print page 1

- Please fill out policy number, Owner & Insured's information

- Policy Owner - Please sign on the bottom of the page by OWNER'S SIGNATURE

- Please Email at aspatel@nyl.com OR Fax Signed form at 251-460-0678 Attn: AL PATEL

- Please contact Meena at 251-377-3253 if you have any questions

Check-O-Matic Loan Repayment Form

- Please open the attached C-O-M Loan Repayment Form and print page 3 and 4

- Page 3 - Please include Policy Number, Insured Name and Loan Repayment amount.

Page 3 - Please fill out the Bank Account information where the BLUE HIGHLIGHTED LINES are (Such as Account holder name, Address, Bank Name, Routing Number, Account Number)

- If this is business checking account - Please fill out 3rd Party Payor information on Page 3 Including the BUSINESS TAX ID NUMBER.

- Page 4 - Please Sign & Date by Depositor's Signature.

- Please Email at aspatel@nyl.com OR Fax Signed forms at 251-460-0678 Attn: AL PATEL

Please contact Meena at 251-377-3253 if you have any questions

Check-O-Matic Request Form

- Please open the attached C-O-M Form and print page 3 and 4

- Page 3 - Please fill out the Bank Account information where the BLUE HIGHLIGHTED LINES are (Such as Account holder name, Address, Bank Name, Routing Number, Account Number)

- If this is business checking account - Please fill out 3rd Party Payor information on Page 3 Including the BUSINESS TAX ID NUMBER.

- Page 4 - Please Sign & Date by Depositor's Signature.

- Please Email at aspatel@nyl.com OR Fax Signed forms at 251-460-0678 Attn: AL PATEL

Please contact Meena at 251-377-3253 if you have any questions

Change of Beneficiary Request Form

- Please open the attached Beneficiary Change Form and print page 1-3

- Page 3 - Policy Owner- Please sign by POLICY OWNER SIGNATURE.

- Please Email at aspatel@nyl.com OR Fax Signed forms at 251-460-0678 Attn: AL PATEL

Please contact Meena at 251-377-3253 if you have any questions

Collateral Assignment Form Instructions

- Please open the attached Beneficiary Change Form and print page 1-3

- Page 3 - Policy Owner- Please sign by POLICY OWNER SIGNATURE.

- Please Email at aspatel@nyl.com OR Fax Signed forms at 251-460-0678 Attn: AL PATEL

Please contact Meena at 251-377-3253 if you have any questions

Name Change Request Form

- Please open the attached Name Change Request Form and print page 1

- Please fill out all the information on this page

- Please sign by POLICY OWNER SIGNATURE

Please Email at aspatel@nyl.com OR Fax Signed form at 251-460-0678 Attn: AL PATEL

A copy of the marriage certificate, certificate of naturalization, or court document is required to change a name

Please contact Meena at 251-377-3253 if you have any questions

Policy Loan Request Form

- Please open the attached Policy Loan Request Form and print page 1-5

- Page 1 - Please fill out Policy Number, Insured Name and Loan amount

- Page 3 - Please fill out Income Tax Withholding Election section

Page 4 - Owner - Please sign by Policy Owner's signature

Please Email at aspatel@nyl.com OR Fax Signed form at 251-460-0678 Attn: AL PATEL

Please contact Meena at 251-377-3253 if you have any questions

Release of Assignment Form

- Please open Attached Release of Assignment Form and print page 2

- Page 2 - Please include policy number, insured name, address and assignee's name

- Page 2 - Two bank officers need to sign by Assignee's Signature with their title.

Please Email at aspatel@nyl.com OR Fax Signed form at 251-460-0678 Attn: AL PATEL

Please contact Meena at 251-377-3253 if you have any questions