Administration Forms

The forms provided here are standard Administration forms. See the other links on the sidebar for Claim Forms. If any form you need is listed as "TBD" then please contact your Account Representative to order a paper supply as indicated in your Administration Manual. Any Enrollment forms and Evidence of Insurability forms must be obtained through your local Account Representative.

• Request for Change form
• Amendment to Original Application (Life Insurance)
• Beneficiary Designation form (Life Insurance)
• Absolute Assignment of Life Insurance form
• Statement of Intent (Life Insurance)
• Life Conversion Information Request Form
• Term Life Coverage Continuation Request form
• Long Term Disability (Monthly Income Benefits) Conversion Information Request Form
• Authorization for Electronic Funds Transfer (Disability Income Insurance)

Employee Benefits insurance products and services in the U.S. are provided by ReliaStar Life Insurance Company (Minneapolis, MN) and ReliaStar Life Insurance Company of New York (Woodbury, NY). Within the State of New York, only ReliaStar Life Insurance Company of New York is admitted, and its products issued. Both are members of the ING family of companies. Product availability and specific provisions may vary by state. Each insurer is solely responsible for the financial obligations under the policies or contracts it issues.