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USA Senior Care Network

VSP

Service Forms

Below are the forms needed for your policy contracts. If you need assistance selecting the proper form, please call our customer service department at (888) 863-6674.

Address Change Form
Annuitant Change Form
Annuitization Election Form
Annuity Full Surrender Form
Annuity Interest Only Withdrawal Form
Annuity Withdrawal Form
Banking Change Form (Final Expense Life Insurance)
Banking Change Form (Medicare Supplement)
Beneficiary Form
Direct Deposit Authorization
Duplicate Policy Request
GLWB Election Form
Indexed Annuity Reallocation Form
Information Release Authorization
Life Insurance Surrender/Cancellation Form
Life Single Premium Surrender and Cancellation Form
Loan Agreement Form
Name Change Form
Ownership Change Form (Life Insurance)
Ownership Change Form (Annuities)
Policy Date Change Form
Policy Maturity Election Form
Power of Attorney Certification
Qualified Charitable Distribution Form (QCD)
Reduce Assurance Face Amount Request Form
Required Minimum Distribution (RMD) Request Form
Trustee of Powers Certification

Annuity Claim Form
Estate as Policy Beneficiary Guidelines
Trustee of Powers Certification
IRA Stretch Form Post 1/1/2020
IRA Stretch Form Pre 1/1/2020
Spousal Continuation Request Form

Beneficiary's Assignment of Policy Proceeds
Estate as Policy Beneficiary Guidelines
Health Related Information Release Authorization
HIPPA - Living Benefit
Important Information for Contestable Claims
Life Claim Form
Medical Provider Information (MPI)
Trustee of Powers Certification
W-9 Form

Beneficiary's Assignment of Policy Proceeds
Estate as Policy Beneficiary Guidelines
Life Claim Form
Non-Contestable Policy Required Documentation
Trustee of Powers Certification
W-9 Form

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