Federal Life Insurance Company (Mutual)

Contract Changes - Annuities

Choose one of the following:

• Call our Annuities department at (800) 233-3750 ext. 510.
• FaxFAX# (847) 520-0848, mailFederal Life Insurance Co.(Mutual) 3750 West Deerfield Rd Riverwoods, Il 60015 or emailpolicyservices@federallife.com a written request (please indicate the contract number and whose address you are changing).
• Complete and return the change notification slip attached to your premium billing envelope.

Complete a Contract Change Form: L-5454 and send it to us by mailFederal Life Insurance Co.(Mutual) 3750 West Deerfield Rd Riverwoods, Il 60015, faxFAX# (847) 520-0848, or emailpolicyservices@federallife.com.
This form requires the following information:
• Contract number
• Annuitant name
• Owner name
• Complete all items in Section 1 on this form (If this request is for reasons other than indicated in this section or as a result of court order or adoption, legal evidence of the name change must be provided with the request.)
• Obtain the required signatures at the bottom of the form (Insured, Owner if other than Annuitant Insured, Beneficiary if irrevocable, and a Witness signature)

Complete Statement of Lost Contract Form: L- 5431 and send it to us by mailFederal Life Insurance Co.(Mutual) 3750 West Deerfield Rd Riverwoods, Il 60015, faxFAX# (847) 520-0848, or emailpolicyservices@federallife.com.

Upon receipt of this form, we will mail you a copy of your original contract and application.

Complete Ownership/Contingent Ownership Designation Form: L-5535 and send it to us by mailFederal Life Insurance Co.(Mutual) 3750 West Deerfield Rd Riverwoods, Il 60015, faxFAX# (847) 520-0848, or emailpolicyservices@federallife.com.

Please Note:


• When the current contract owner is a business or trust, the form must include the name of the business or trust, and the title of the person signing. The person who signs should not be the person insured or the person who will benefit from the change.
• After we have accepted and recorded the information on your owner designation form, the change will be effective the date the form was signed.
• Changing the ownership of a policy does not change the beneficiary
• Changing the ownership of a policy does not change the payor.
• There may also be tax consequences to having your life insurance policies or annuities owned by a trust, or by other family members who will be the beneficiaries. You may want to consult your tax advisor prior to requesting a change in ownership.



PLEASE NOTE: Changing ownership of an annuity is a taxable event. Personal tax situations and your use of annuities should be reviewed with your attorney and/or tax advisor.

Complete Change of Beneficiary Form: L-5514 and mailFederal Life Insurance Co.(Mutual) 3750 West Deerfield Rd Riverwoods, Il 60015 it to us.

Please Note:
• The only person authorized to change a beneficiary is the owner of the contract. When the owner is a business or trust, the form must include the name of the business or trust, and the title of the person signing. That person should not be the person insured or the person who will benefit from the change.
• If you live in Arizona, California, Idaho, Louisiana, Nevada, New Mexico, Texas, Washington or Wisconsin the signature of your spouse is required, except where one of the following items apply:
1. You are submitting a copy of court documentation awarding you sole ownership of this asset with your completed change form.
2. You are submitting a copy of the death certificate in the event your spouse has passed away with your completed change form.
3. You are Power of Attorney for your spouse, and are submitting a copy of the POA appointment with your completed change form.
4. You will be indicating NEVER MARRIED in the area where a spouse's signature is required on the completed change form.
• If your current beneficiary is irrevocable, their signature for authorization is required.
• If your contract is collaterally assigned, the change must be authorized/requested by the assignee or the assignment released prior to the request for change.


Naming More Than One Beneficiary You may name multiple beneficiaries. All death benefits will be paid in equal proportion to all beneficiaries who survive and receive payment, unless you specify otherwise. To distribute the death benefit unequally, indicate what fraction or percentage you would like each beneficiary to receive. Avoid using dollar amounts. When the claim is made, the amount of the death benefit may not be the same as it is today.


• Changing a Beneficiary's Address You do not need to fill out a form if you are only changing the current beneficiary's address. Simply contact Policyholder Service at (800) 233-3750 ext. 503.
• After we have accepted and recorded the information on your Change of Beneficiary form, the change becomes effective as of the date the form was signed.



If you have any questions please contact Policyholder Service department at (800) 233-3750 ext. 503.