We have great news!

Making changes to your policy just got easier!

Simply choose the form from the options below.
Complete the form, print and mail it to the address listed.
 
Or, email the completed form to:
or fax it to: 603-357-4532.
 
 
 
SelmanCo
 
1 Integrity Parkway
 
Cleveland, OH 44143

 

 

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Service Change Form

The form below will be needed for the following changes:
 
Partial Surrender / Loan, Name Change, Address Change, Transfer of Ownership, Payment Changes
 
Complete Online Change Form
 
 

Beneficiary Change Form

In order to make any changes to your beneficiary, the form below must be completed and mailed to the address listed above. All sections must be completed and you MUST include the social security number of the beneficiary.
 
If you are listing more than one beneficiary, the percentage of all beneficiaries must equal 100%.
 
Complete Online Beneficiary Change Form
 
 

Full Surrender Form

Complete surrender of policy - Please use the form below.
 
Complete Online Full Surrender Form