Policy Owner Forms

The following Homesteaders Life Company insurance service forms are available in PDF format. Please select the appropriate form, print and complete. The form may be mailed, faxed or emailed to our office.

Our mailing address is PO Box 1756, Des Moines, IA 50306-1756. If emailing, please send to service@homesteaderslife.com. Our fax number is 515-440-7695.

If you have any questions regarding the completion of these forms, please contact our customer service team at 800-477-3633. Our business hours are 8 a.m. to 4 p.m. Monday through Thursday, and 8 a.m. to 1 p.m. Friday (Central time).

  • Customer Service Request

    Use this form for policy change requests including nonforfeiture, cash surrender and plan/benefit changes. Please note that this form requires a witness signature and the policy owner’s Social Security or Tax ID where indicated.
  • Request for Duplicate Policy

    This form is used to request a duplicate copy of a policy in the event the original is lost or destroyed.
  • Request for Automatic Payment Plan

    This form is used to authorize recurring automatic premium withdrawals from a checking/savings account.
  • Application for Reinstatement

    This form may be required to reinstate a lapsed or terminated policy.
  • Reinstatement by Redate

    This form is required to reinstate a policy by deferring past-due premiums. Certain restrictions apply to this method of reinstatement.
  • Transfer of Ownership

    This form is required to transfer ownership rights under a Life Insurance or Annuity contract.
  • Name Change

    This form is required to change the legal name of an insured or owner in the event of marriage/divorce.
  • Beneficiary Change

    This form is required to change beneficiary designation on the insurance policy.
  • Address/Phone Change

    Use this form to change the address or phone number for the insured or policy owner. We will also accept these changes from the policy owner by phone.
  • Child/Grandchild Rider Application

    This form is required to add additional children or grandchildren after a Child/Grandchild rider has been issued with the primary coverage insurance policy.


  • Add-On Rider

    This form is used to add a single premium rider to an existing Homesteaders policy. The minimum premium requirement for the rider is $100. If the policy is funding a prearranged funeral agreement, a representative of the assigned funeral home must also sign the form before submitting to Homesteaders. 

    A copy of the completed form should be retained by the policy owner and, if applicable, the associated funeral home.