Life Insurance Forms
Find and download the form you need. Print, complete, and sign. Then mail or fax it to:
Vantis Life
PO Box 310
Millville, NJ 08332-0310
Overnight address
Vantis Life
302 High St #310
Millville, NJ 08332-0310
Fax 860-298-5483
Questions? Call customer service at 1-866-826-8471. We are available Mon-Fri 8:30am - 6:00pm ET.
The forms are in Adobe PDF format.
| Assignment of Life Insurance Policy as Collateral | Download | ||
| Beneficiary Change (For all states except MA, NY) | Download | ||
| Beneficiary Change (For MA) | Download | ||
| HIPAA Authorization | Download | ||
| Ownership Change Request Form | Download | ||
| Policy Change Request Form | Download | ||
| Reinstatement Request (For all states except CA, DE, FL, ND, NY, SD) | Download | ||
| Reinstatement Request (For CA, DE, FL, ND, SD) | Download | ||
| Release of Assignment | Download | ||
| Request for Certificate of Insurance/Duplicate Policy | Download | ||
| Request for Rate Reduction (For all states except CA, DE, FL, ND, NY, SD) | Download | ||
| Request for Rate Reduction (For CA, DE, FL, ND, SD) | Download | ||
| Termination Request Form | Download | ||
The following forms are specific to NY state customers:
Find and download the form you need. Print, complete, and sign. Then mail or fax it to:
The Penn Insurance and Annuity Company of New York
PO Box 390
Millville, NJ 08332-0390
Overnight address
The Penn Insurance and Annuity Company of New York
302 High St #390
Millville, NJ 08332-0390
Questions? Call customer service at 1-855-436-0952. We are available Mon-Fri 8:30am - 6:00pm ET.