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 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 Friday, 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.

English    Español

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.

English    Español

Request for Automatic Payment Plan

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

English    Español

Application for Reinstatement

This form may be required to reinstate a lapsed or terminated policy.

English    Español

Reinstatement by Redate

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

English    Español

Transfer of Ownership

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

English    Español

Name Change

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

English    Español

Beneficiary Change

This form is required to change beneficiary designation on the insurance policy.

English    Español

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.

English    Español

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.

Additional Spanish-language translations of this form will be available soon.

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.

English    Español