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

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  
Beneficiary Change  
(For all states except MA, NY)
Download  
Beneficiary Change 
(For MA)
Download  
HIPAA AuthorizationDownload  
Ownership Change Request FormDownload 
Policy Change Request FormDownload  
Reinstatement Request
(For all states except CA, DE, FL, ND, NY, SD)
Download  
Reinstatement Request
(For CA, DE, FL, ND, SD)
Download  
Release of AssignmentDownload  
Request for Certificate of Insurance/Duplicate PolicyDownload  
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 FormDownload  

The following forms are specific to NY state customers:


Assignment of Life Insurance Policy as CollateralDownloade-sign
Beneficiary ChangeDownload 
HIPAA AuthorizationDownload 
Ownership Change Request FormDownload 
Policy Change Request FormDownload 
Reinstatement RequestDownload 
Release of AssignmentDownload 
Request for Certificate of Insurance/Duplicate PolicyDownload 
Request for Rate ReductionDownload 
Termination Request FormDownload