Individual Customer Service Forms

Note: All forms are Adobe Acrobat Portable Document Files (PDF’s). Click on the Adobe icon to receive the latest Acrobat Reader for free.

An original copy must be received by our Home Office unless it states otherwise on the form.

You can mail forms to:
Security Mutual Life Insurance Company of New York
P.O. Box 1625
100 Court Street
Binghamton, NY 13902-1625

If your policy begins with 000, 001, 002

If your policy begins with 00DA

For all other policies

You can mail forms to:
Security Mutual Life Insurance Company of New York
P.O. Box 1625
100 Court Street
Binghamton, NY 13902-1625

Please contact our Home Office at 1-800-346-7171 or contact us and request a form.