Cancellation Form - Voluntary Benefit Coverage 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your personal information, including the Policy Owner’s Name and Mailing Address. Ensure that you check the box if this is a new address.
3. Provide your contact details, including Home Phone Number and Email. Select your preferred contact number and indicate the best time to reach you.
4. In Section 1, specify any policy changes you wish to make. Check the appropriate boxes for changes such as coverage type or adding dependents.
5. For Flexible Premium Payment Changes, indicate whether you want to place the policy in non-billing status or change the premium amount. Specify how often payments will be made.
6. If applying for a duplicate policy, certify that the original has been lost or destroyed by signing in the designated area.
7. Complete any additional instructions in Section 4 and ensure all required signatures are provided before submitting your form.

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