Service Forms
For your convenience, we have provided the most commonly requested forms.
To print and sign, use the fillable form links below.
Do you want to ....
Change Policy Information
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Address Change Request
This form is used to request an address change on a life insurance or fixed annuity policy. -
Ownership, Beneficiary, or Name Change Request Booklet
Used for ownership, beneficiary, or name changes and includes additional forms that may be needed for an ownership change.
Change Authorizations
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Other Interested Party Authorization Request
This form may be used for a life insurance or fixed annuity policy to: authorize an interested party, request and receive policy information, remove an interested party, or stop/start duplicate mailings to an interested party. -
Transaction Authorization (For Telephone Requests)
This form is specific to Variable and Indexed Universal Life Policies. Use to authorize telephone requests for: policy loans, investment option changes, and/or payment and transfer instructions.
Take Money Out of the Policy
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Loan Request
This form is used to request a loan on a life insurance policy. -
Loan Request-M Vision
This form is used to request a loan on a life insurance policy. -
Surrender Request
This form is used to surrender/cancel an existing life insurance or annuity policy. -
Withdrawal Request
This form can be used to request withdrawals of cash value and dividends, and surrender paid-up additional insurance on a life insurance or fixed annuity policy. -
Withdrawal Request-M Vision
This form can be used to request withdrawals of cash value and dividends, and surrender paid-up additional insurance on a life insurance or fixed annuity policy.
Make Billing Changes
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Billing and Premium Change Request
This form is used to request changes to billing and premium information on in-force life insurance policies. -
Electronic Funds Transfer (EFT)
Used to establish, change, or cancel Electronic Fund Transfer information for premium payments and/or policy loan repayments on life insurance policies.
Make an Investment Change
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In Force Variable Life Investment Option Services
This form is used to allocate payments, rebalance and/or transfer investment options using the variable transfer services available on your variable life insurance policy. -
In Force Variable Life Investment Option Services-M Vision
This form is used to allocate payments, rebalance and/or transfer investment options using the variable transfer services available on your variable life insurance policy. -
Indexed Interest Disclosure - IUL
Contains information for products with an indexed account. Must be left with the applicant at the time of solicitation. -
Indexed Products Transfer - PACIFIC DISCOVERY PROTECTOR IUL (PDP)
Used for PDP IUL product to request one-time transfers, payment transfers, Scheduled Indexed Transfers, or segment maturity reallocations. -
Indexed Products Transfer - PACIFIC DISCOVERY XELERATOR IUL (PDX)
Used for PDX & PDX 2 IUL products to request one-time transfers, payment transfers, Scheduled Indexed Transfers, or segment maturity reallocations. -
Indexed Products Transfer - PACIFIC HORIZON IUL
Used for Horizon IUL, Horizon ECV IUL, Horizon SIUL and Horizon IUL 2 to request one-time transfers, payment transfers, scheduled indexed transfers or segment maturity reallocations. -
Indexed Products Transfer - PACIFIC INDEXED ACCUMULATOR (PIA & PIA2)
Used for PIA & PIA 2 IUL products to request one-time transfers, payment transfers, Scheduled Indexed Transfers or segment maturity reallocations. -
Indexed Products Transfer - PACIFIC INDEXED ACCUMULATOR (PIA 3, 4, 5, 6)
Used for PIA 3, PIA 4, PIA 5, PIA 6 IUL products to request one-time transfers, payment transfers, Scheduled Indexed Transfers, or segment maturity reallocations. -
Indexed Products Transfer - PACIFIC INDEXED ESTATE PRESERVER (IPEP)
Used for Pacific Indexed Estate Preserver IPEP, IPEP 2, IPEP 3 IUL products to request one-time transfers, payment transfers, Scheduled Indexed Transfers or segment maturity reallocations. -
Indexed Products Transfer - PACIFIC INDEXED PERFORMER LT (PIP LT)
Used for PIP LT & PIP LT 2 IUL products to request one-time transfers, payment transfers, Scheduled Indexed Transfers, or segment maturity reallocations. -
Indexed Products Transfer - PACIFIC PRIME IUL
Used for PRIME & PRIME 2 IUL products to request one-time transfers, payment transfers, Scheduled Indexed Transfers, or segment maturity reallocations. -
Indexed Products Transfer - PACIFIC TRIDENT IUL
Used for Trident IUL product to request one-time transfers, payment transfers, scheduled indexed transfers or segment maturity reallocations. -
Indexed Products Transfer - PIA PROTECTOR (PIA PRO & PIA PRO 2)
Used for PIA PRO & PIA PRO 2 IUL products to request one-time transfers, payment transfers, Scheduled Indexed Transfers, or segment maturity reallocations.
Request Summary of Your Policy
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Certificate of Insurance/Duplicate Policy Request
This form is used to request a Certificate of Insurance or a duplicate policy on life insurance or fixed annuity policies.
Request a Duplicate Copy of Your Policy
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Certificate of Insurance/Duplicate Policy Request
This form is used to request a Certificate of Insurance or a duplicate policy on life insurance or fixed annuity policies.
Questions?
Call Customer Service(800) 347-7787
Monday - Friday
6:00 AM - 5:00 PM Pacific Time
(excluding holidays)
Send completed forms to:
Mailing Address:
Pacific Life Insurance Company
Life Insurance Division
P.O. Box 2030
Omaha, NE 68103-2030
Fax: (866) 398-0467
Email: PolicyService@PacificLife.com
Mailing Address:
Pacific Life Insurance Company
Life Insurance Division
P.O. Box 2030
Omaha, NE 68103-2030
Fax: (866) 398-0467
Email: PolicyService@PacificLife.com
