Policy Service Forms

For your convenience, we have provided some commonly used forms to help you manage your policy(s). To request a form to make a policy change, simply choose the appropriate form from the list below, then:

Print the form, complete and sign it.
Fax or mail the form as stated in the instructions listed next to the form.
Your form will be processed upon receipt. We will contact you if additional information is needed.

Note: Please do not save blank copies of these forms as they are periodically updated. Always return to the Web site to get the most current version.

Life/Annuity Policy Forms

Beneficiary Designation

	1. Use this form to: -Change or update your beneficiary -Add a contingent beneficiary 2. Print the form, complete and sign it. 3. If any designations are trusts, please send a copy of the first page following the cover page and the signature page of the trust document with your form. 4. Fax your completed form to 800-754-6370 OR Mail to: Farm Bureau Life, PO Box 9168,Des Moines, IA 50306 5. Your form will be processed upon receipt. We will contact you if additional information is needed. Note: Please do not save blank copies of these forms as they are periodically updated. Always return to the Web site to get the most current version. If you have any questions call 800-247-4170, Monday – Friday 8:00 am – 4:30 pm CST.

Dollar Cost Averaging - Automatic Rebalancing - Interest Sweep - Systematic Withdrawal

Variable Policy Service Request

	1. Use this form to: -Change premium allocations -Transfer subaccount values -Change the allocation of charges -Request a partial surrender -Request surrender 2. Print the form, complete and sign it. 3. Fax your completed form to 800-754-6370 OR Mail to: Farm Bureau Life, PO Box 9168, Des Moines, IA 50306 4. Your form will be processed upon receipt. We will contact you if additional information is needed. Note: Please do not save blank copies of these forms as they are periodically updated. Always return to the Web site to get the most current version. If you have any questions call 800-247-4170, Monday – Friday 8:00 am – 4:30 pm CST.

Electronic Funds Transfer (EFT) Form

	1. Use this form to: -Set up automatic monthly withdrawals from your bank account to pay premiums -Change the bank account where your premiums are currently being withdrawn -Be sure to attach a voided check -The form must be signed by the bank account owner 2. Print the form, complete and sign it. 3. Fax your completed form to 800-754-6370 OR Mail to: Farm Bureau Life, PO Box 9168, Des Moines, IA 50306 4. Your form will be processed upon receipt. We will contact you if additional information is needed. Note: Please do not save blank copies of these forms as they are periodically updated. Always return to the Web site to get the most current version. If you have any questions call 800-247-4170, Monday - Friday 8:00 am - 4:30 pm CST.

Automatic Deposit Authorization Agreement

	1. Use this form to automatically deposit funds into a specific financial institution. 2. Print the form, complete and sign it. 3. Fax your completed form to 800-754-6370 OR Mail to: Farm Bureau Life, PO Box 9168 , Des Moines , IA 50306 4. Your form will be processed upon receipt. We will contact you if additional information is needed. Note: Please do not save blank copies of these forms as they are periodically updated. Always return to the Web site to get the most current version. If you have any questions call 800-247-4170, Monday – Friday 8:00 am – 4:30 pm CST .

Power of Attorney Certification

	Use this form to certify the validity of an attorney.

Policy Service Request

	1. Use this form to: -Make changes on your policy such as ü Address ü Name ü Premium payments ü Dividend options -Request a loan -Transfer ownership -Request a dividend withdrawal -Request a partial withdrawal on a universal life plan -Request surrender of the policy -Request EFT (electronic forms transfer) -Request entity information -Request trust information -Change beneficiary designation 2. Print the form, complete and sign it. 3. Fax your completed form to number located on top right corner of form OR Mail to: Farm Bureau Life, PO Box 9168 , Des Moines , IA 50306 4. Your form will be processed upon receipt. We will contact you if additional information is needed. Note: Please do not save blank copies of these forms as they are periodically updated. Always return to the Web site to get the most current version. If you have any questions call 800-247-4170, Monday – Friday 8:00 am – 4:30 pm CST .

Entity Information Form Certification and Indemnification Agreement

	1. Use this form to: -Provide information regarding an entity which is named as an owner of a policy or contract -Provide information regarding an entity which is named as an owner of a policy or contract -Change or update entity information 2. Print the form, complete and sign it. 3. If any designations are trusts, please send a copy of the first page following the cover page and the signature page of the trust document with your form. 4. Fax your completed form to 800-754-6370 OR Mail to: Farm Bureau Life, PO Box 9168 , Des Moines , IA 50306 5. Your form will be processed upon receipt. We will contact you if additional information is needed. Note: Please do not save blank copies of these forms as they are periodically updated. Always return to the Web site to get the most current version.

Trust Information Form and Trustee Certification and Indemnification Agreement

	1. Use this form to: -Provide information regarding a Trust which is named as an owner of a policy or contract -Change or update trust information 2. Print the form, complete and sign it. 3. If any designations are trusts, please send a copy of the first page following the cover page and the signature page of the trust document with your form. 4. Fax your completed form to 800-754-6370 OR Mail to: Farm Bureau Life, PO Box 9168 , Des Moines , IA 50306 5. Your form will be processed upon receipt. We will contact you if additional information is needed. Note: Please do not save blank copies of these forms as they are periodically updated. Always return to the Web site to get the most current version.

Securities & services offered through FBL Marketing Services, LLC+, 5400 University Ave., West Des Moines, IA 50266, 877/860-2904, Member SIPC.

Property-casualty insurance products are offered through Farm Bureau Property & Casualty Insurance Company+* and Western Agricultural Insurance Company+*/West Des Moines, IA and are intended for residents of AZ, IA, KS, MN, NE, NM, SD and UT.

Fixed life insurance and annuity products are offered through Farm Bureau Life Insurance Company+*/West Des Moines, IA and are intended for residents of AZ, IA, ID, KS, MN, MT, ND, NE, NM, OK, SD, UT, WI and WY.

Variable life insurance and annuity products are underwritten by an insurance company that is not affiliated with our companies.

+Affiliates *Company providers of Farm Bureau Financial Services

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