| Form Name |
Description |
PDF |
| Beneficiary Change Form |
Change the beneficiary of your policy with this easy-to-use form. |
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| Pre-Authorized Check Premium Payment Service |
Complete this form to have premiums automatically deducted from your bank account or to change the bank name and account of an existing automatic draft. |
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| Survivorship/Variable Universal Life Directed Monthly Deduction Program Request |
Please use this form to elect to have monthly policy charges deducted from your account value in one investment option, rather than from all options on a pro rata basis. |
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| Standing Dividend Order Form |
Elect to have your premiums and/or policy loan interest paid by the policy's dividend. This selection can include one or more MassMutual Financial Group companies' policies, provided the same person owns each policy. |
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| Request for Change of Dividend Option |
Use this form to change your policy's Dividend Option. (You may also change your option online on the Life Service Connection.) |
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| Service Request Surrender Dividends |
This form may be used to request a dividend withdrawal from your policy, to add or remove the automatic premium loan provision, or to elect to change your policy to reduced paid-up or extended term insurance. |
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| Lost Policy Agreement Request |
Used for replacement of a policy you cannot locate. *$25.00 fee |
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| Taxpayer Identification (W-9) |
This will certify your Social Security number with MassMutual. |
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| Loan Repayment Authorization |
If you have a loan on your policy, use this form to automatically set up monthly repayment directly from your checking account. |
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| Change Request |
Use this form to change the premium payer name and address; change or correct the name of the insured, owner, beneficiary, payer or payee; change the premium payment mode; change the dividend option; change or exercise the non-forfeiture option; add or revoke the Automatic Premium Loan (APL) provision; use dividends to repay the loan; and cancel Modified Payment Option (MPO) authorization. This form can only be used for policies issued by CM Life. |
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| Multiple Owner and Beneficiary Request |
Use this form for individual name changes, corporate name changes (not due to sale or merger), premium payer name changes, releasing collateral assignments and submitting Affidavit of Death, if the death certificate for a deceased owner is not available. This form cannot be used to change the owner of a policy.
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| Cancellation of Standing Dividend Order (SDO) or Standing Loan Order (SLO) |
Use this form to cancel SDO or SLO. |
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| Partial Standing Dividend Order, Modified Whole Life Policies |
Use this form to establish a Mod 5 Whole Life policy on Standing Dividend Order (SDO) beginning in the sixth policy year or later. Partial SDO allows use of dividends to pay the difference between the initial and ultimate premiums. |
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| Modified Payment Option (MPO) Authorization |
Use this form to elect the MPO for policies issued by CM Life. Included with the form is our MPO brochure, "Premiums and the Modified Payment Option," form F6873, to be retained by the policy owner. |
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| Request to Pay Dividend, Surrender Add'l Benefits Rider or Flexible Term Rider, or Change Dividend Option |
Complete this form to request a Dividend Option Change or Surrender of Dividends on policies originally issued by Connecticut Mutual. |
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Policy Loans
Please use these forms to apply for a policy loan. |
| Request for Policy Loan |
Use this form to apply for
a policy loan. (You may also apply for a policy loan
online through the Life Service Connection, however
loan requests for a Variable Life policy always require
a form.) |
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| Request for Policy Loan (Qualified Plans) |
Use this form for loans from policies that are part of a Qualified Retirement Plan (Pension, Profit sharing, etc.). |
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| VUL Guard/SVUL Guard Request for Policy Loan |
Use this form to apply for a VUL Guard/SVUL Guard policy loan. |
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Allocation Changes
For changing the allocation into specific Separate Investment Account(s) of future payments into your Variable Life (VL) or VUL Guard/SVUL Guard contract - does not affect monies already in the contract. |
| Survivorship/Variable Universal Life Allocation Change Request |
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| VUL Guard/SVUL Guard Allocation Change Request |
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Transfer of Values
For transfering money already in your Survivorship/Variable Universal Life or VUL Guard/SVUL Guard contract from one or more divisions of the Separate Account to another or the Guaranteed Principal Account. |
| Survivorship/Variable Universal Life Transfer of Values Request |
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| VUL Guard/SVUL Guard Transfer of Values Request |
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Dollar Cost Averaging
For automated, periodic transfers of invested monies from one or more division of the Separate Account to one or more other divisions and/or the Guaranteed Principal Account. |
| Survivorship/Variable Universal Life Dollar Cost Averaging Request |
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| VUL Guard/SVUL Guard Dollar Cost Averaging Request |
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Portfolio Rebalancing
For automated, periodic transfers of invested monies among specified divisions of the Separate Account. |
| Survivorship/Variable Universal Life Portfolio Rebalancing Request |
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| VUL Guard/SVUL Guard Portfolio Rebalancing Request |
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| Variable Life Product Unscheduled Portfolio Rebalancing Request |
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Withdrawals
Please use these forms to request a withdrawal. |
| Survivorship/Variable Life Partial Withdrawal Request |
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| VUL Guard Partial Withdrawal Request |
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