Individual Customer Service Forms
Note: All forms are Adobe Acrobat Portable Document Files (PDFs). Click on the Adobe icon to receive the latest Acrobat Reader for free.
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
Assignment of Life Insurance Policy as Collateral
Application for Partial Surrender of a Universal Life Insurance Policy
Application for Partial Surrender of an Annuity Contract
Business Entity Ownership Certification
Request for Electronic Funds Transfer (EFT) Payment
If you need assistance in completing any of these forms, please feel free to contact our Individual Client Services at 1-800-765-6668 and one of our representatives will be happy to help you.
If your policy begins with 00DA
Absolute Assignment of Life Insurance Policy (Change of Ownership)
Assignment of Life Insurance Policy as Collateral
Application for Partial Surrender of an Annuity
Business Entity Ownership Certification
Change of Beneficiary Individual
Request for Electronic Funds Transfer (EFT) Payment
If you need assistance in completing any of these forms, please feel free to contact our Auxiliary & Custodial Funds department at 1-800-632-6567 and one of our representatives will be happy to help you.
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.