Instructions
Use your life insurance policy as collateral with this form.
- Complete form
Provide information according to the instructions on the form. - Requirements
Complete the insured name, policy number, owner's signature, address and date. The request must contain the assignee's name, address, loan number and amount of the loan. - Signatures
Signatures must be witnessed or notarized and signed within 30 days of receipt. The form must also contain original signatures. - Changes involving a corporation
Corporate changes require the signatures of two corporate officers along with their titles. - Power of attorney
Requests from a power of attorney (POA) require that F&G have current (less than 6 months) POA documentation. - Submit form
Return the completed forms with any required documentation via U.S. mail, overnight mail or fax to our service center.
Postal mail
F&G Service Center
P.O. Box 81497
Lincoln, NE 68501-1497
Overnight mail
F&G Service Center
777 Research Drive
Lincoln, NE 68521
Fax
800.281.5777
Allow 3 business days for faxed documents to enter our processing system. - Confirmation
A confirmation of this change will be mailed to the owner's address on record upon completion.
Assignment of Insurance Policy as Collateral
[ADMIN 5519]
Download ADMIN5519
22-0084