Foresters Life Insurance and Annuities Customer Care

Please note that your address change instruction will apply to any policy that you had with Foresters Life Insurance and Annuity Company (now Nassau)

Address Change Request Form

Please note that your name change instruction will apply to any policy you had with Foresters Life Insurance and Annuity Company (now Nassau)

Name Change / Correction Form 

Request for Change of Ownership

Request for Change of Beneficiary

Lifeline Premium Payment Application

W-9

Statement of Lost Contract/Policy & Request for Duplicate

Life Insurance Policy Loan Request Form

ISP CHOICE Variable Life Insurance Policy

 Subaccount Reallocation Form Life and Annuities 2

Insured Series Policy Variable Life Insurance Policy (ISP)¹

Subaccount Reallocation Form Life and and Annuities 1

Single Premium Variable Life/Variable Universal Life Insurance Policy (SPVL/VUL) 

Subaccount Reallocation Form Life and Annuities 2

 

¹The Insured Series Policy variable life insurance policy is no longer available for sale.

ISP CHOICE Variable Life Insurance Policy

Automated Subaccount Reallocation-Systematic Form  

Single Premium Variable Life/Variable Universal Life Insurance Policy (SPVL/VUL)

Automated Subaccount Reallocation-Systematic Form

By Phone: Call our toll-free claims number at 800-832-7783 to report the death. Our hours of operation are 9 a.m. to 6 p.m. Eastern Time Monday to Friday. A Claims Representative will ask for certain information that will help get your claim started. For example, they will need the name of the deceased member or policy holder and the contact information of the person where forms are being sent.

We will also ask for the date of death of the deceased member or policy holder, along with the cause and manner of death, if available. We will mail the claim form packet to the address provided by the contact.

Direct Submission: Download the appropriate claim forms here:

• Life Claimant Statement
• Life Claimant Statement NY
• Life Claimant Statement Form Instructions

Complete all applicable sections of the claimant’s statement and mail along with the requested documents to: Nassau, PO Box 22012, Albany, NY 12201-2012 .

To submit a claim, the beneficiary needs to complete a claimant’s statement and provide a certified death certificate. If the claim is contestable, or related to a living benefit, a medical authorization will also be required. This information will be outlined in your claim packet.

If the death is due to an accident or homicide, the beneficiary should also provide any information available that relates to the cause and manner of death, including but not limited to, a copy of the police report, any news articles, and/or a coroner’s report and a toxicology report. Once this information is received and reviewed by a Claims Adjudicator, it may be necessary to require additional medical information.

A non-contestable claimant’s statement contains two sections; one section is for information about the deceased member or policy holder and the other section is for information about the person making the claim.

A contestable claimant’s statement requests the same information, and in addition has a medical information section, which also includes a HIPAA authorization. All beneficiaries (or executor/trustee/guardian if applicable) must complete a claimant’s statement.

• Life Claimant Statement
• Life Claimant Statement NY

Most funeral homes will help the family of the deceased obtain a certified death certificate. You can also obtain this document from the Vital Records Division in the state of the deceased. Certified death certificates have either a raised seal or a multicolored signature seal from the county, city or state that issued the certificate. In addition, the original death certificate should contain the signature of an appropriate office of the county, city or state that issued the death certificate.

Once a claim has been approved for payment, any benefit owed will be paid by check and mailed to the beneficiary’s address provided on the claimant’s statement. Please allow at least 10 business days for review and mailing of the benefit.

Primary Beneficiary
A beneficiary, or primary beneficiary, is the person(s) or entity who has been designated to receive the life insurance proceeds upon the death of the insured person. The beneficiary is named in the insurance application when a policy is taken out and can be changed at the request of the policy owner.

Contingent Beneficiary
A contingent beneficiary is the person or party who has been designated to receive the life insurance policy proceeds if the primary beneficiary should die before the person whose life is insured.

This information will be reviewed and confirmed at claim time.

If the primary beneficiary is deceased, we will need a certified death certificate for any designated beneficiary that predeceased the insured.

When the beneficiary is an estate, the court-appointed executor should complete the claimant’s statement, the medical authorization (if applicable), and provide a copy of the court papers appointing the individual as the executor of the estate. In some states, if the value of the estate is under an established threshold, we can consider paying under Small Estate limits. If the estate will not to be probated, please contact us to discuss further.

When the beneficiary is a trust, the Trustee should complete the claimant’s statement, the medical authorization (if applicable), and provide a copy of the trust agreement. In addition, the Trustee should supply a statement advising the Trust named as the beneficiary is still in full force and effect. If the Trust is no longer active, we will need confirmation of this and the benefit will then fall to the Contingent Beneficiary. If no Contingent Beneficiary is listed, the benefit will fall to the Estate of the Owner.

The claimant statement should be completed by the legally appointed guardian of the Estate of the minor and a certificate of the guardian’s appointment from the court must be furnished. In some states, if the value of the benefit is under a certain threshold, we may be able to pay under the Uniform Transfer to Minors Act (UTMA). If there is no legally appointed guardian of the Estate of the minor, please contact us to discuss.

You must provide an official death certificate issued in the country where the death occurred, along with a notarized translation of the death certificate. We also require a Foreign Death Questionnaire be completed and submitted along with a copy of the decedent’s passport. If the decedent was a U.S. citizen, we will also need a completed Report of the Death of an American Citizen Abroad (may be obtained from the local US Embassy or Consulate). Once we have the requested information, we may further investigate in the country where the death occurred.

Life Claimant Statement

Life Claimant Statement NY

Life Claimant Statement Form Instructions