Nationwide Life Insurance Forms
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Life Insurance Forms & Applications

Print the life insurance form you need and mail it to the address on the form.

Life Policy Owner’s Service Request Form

Make account updates, including:
   • Name
   • Address
   • Dividend options
   • Billing mode
   • Planned periodic premium

Application for Change of Beneficiary Designation

Change the primary and/or contingent beneficiaries. Form also includes information about beneficiary designations.

Duplicate Policy Request

Request a duplicate copy of your policy.

Loan, Partial Surrender & Dividend Withdrawal Request Form

Application requests for such information as:
   • Policy loan options
   • Partial surrender options
   • Dividend withdrawal amount
   • Method of distribution
   • Federal tax withholding information
   • Taxpayer ID certification

*IMPORTANT: RESIDENTS OF KENTUCKY, MAINE, OREGON AND WASHINGTON, PLEASE SEE BELOW.

Required information for Kentucky residents

Definitions of commonly used insurance terms and related information from the Commonwealth of Kentucky’s Department of Insurance, Commissioner’s Office

Required information for Maine residents

Definitions of commonly used insurance terms and related information from the Maine Bureau of Insurance

Required information for Oregon residents

How to contact the Oregon Insurance Division and Oregon Department of Consumer & Business Services

Required information for Washington residents

Definitions of commonly used insurance terms and related information from the State of Washington Office of the Insurance Commissioner

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