Pacific Life - My Life Insurance Account

For your convenience, we have provided the most commonly requested forms.

To print and sign, use the fillable form links below.

To submit forms electronically, log in and select "Policy & Billing Changes" under the "Self - Service Policy Management" menu.

Billing and Premium Change Request
This form is used for billing and premium changes.
Electronic Funds Transfer Authorization for Renewal Premiums
This form is used to establish and change EFT requests for premium payment.
Release of Assignment
This form is used to release a collateral assignment when a debt has been repaid on a collaterally assigned policy. A policy will remain collaterally assigned until this form is completed and returned to PL.

Authorization to Exercise Ownership Rights
This form is used for policy owned by business entities and other organization, or for other ownership arrangements to notify PL who is authorized to sign on behalf of the Policy Owners when exercising the policy's ownership rights
Certificate of Insurance/Duplicate Policy Request
This form is used to request a Certificate of Insurance or a duplicate policy on insurance policies.
Collateral Assignment
This form is used to assign a policy as collateral security for an obligation owed to a bank, company or individual. It’s execution transfers certain contractual rights from the policy owner to the assignee
Other Interested Party Authorization Request
This form may be used to authorize an interested party, request and receive policy information, remove an interested party to stop/start duplicate mailing to an interested party.
Producer Change Request
This form is used to replace any existing Producer/Agency that services the policy/contract with the New Producer/Agency named

Service Forms