Statement of Intent

If group life insurance was assigned under a prior group policy, then in order to continue the assignment under the new Group Policy the insured person and the owner must complete and sign a Statement of Intent form.

The completed form must be sent to the insurer for approval, along with copies of all enrollment forms or applications, beneficiary designations and the prior absolute assignment.

Form for Association Group Term LifeForm Number

Statement of Intent form for group life policies issued by ReliaStar Life Insurance Company

24661h (114963)

Statement of Intent form for group life policies issued by ReliaStar Life Insurance Company of New York

46559d (116013)

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