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:
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.
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.
If you have any questions call 800-247-4170, Monday – Friday 8:00 am – 4:30 pm CST.
1. Use this form to:
-Change premium allocations
-Transfer subaccount values
-Change the allocation of charges
-Request a partial surrender
-Request surrender
-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
3. Fax your completed form to number located on top right corner of form OR
-Provide information regarding an entity which is named as an owner of a policy or contract
-Change or update entity information
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
5. Your form will be processed upon receipt. We will contact you if additional information is needed.
-Provide information regarding a Trust which is named as an owner of a policy or contract
-Change or update trust information
-Change or update your beneficiary
-Add a contingent beneficiary
-Dollar Cost Average
-Interest Sweep
-Automatic Rebalancing
-Systematic Withdrawal
1. This form may be filled out on your computer prior to printing and signing, or may be printed and then completed.
2. Determine if the rated youthful operator qualifies for the Good Student Credit by reviewing the eligibility guidelines listed on the verification form.
3. If the youthful operator qualifies for the credit, complete the following information fields:
-Personal Package Policy #
-Policy Renewal Date
-Vehicle Year
-Vehicle Make
-Vehicle Model
-Vehicle Identification Number (VIN)
-Rated Youthful Driver
4. Upon completion of the form, deliver or mail to your Farm Bureau agent for application of the Good Student Credit, at least 30 days prior to the policy’s renewal date. To find your agent’s mailing address, click the “Find an Agent” link at the top of the page.
If you have any questions, please contact your agent or call 866-399-3237, Monday - Friday 7:30 am - 6:00 pm CST.
1. This form may be filled out on your computer prior to printing and signing, or may be printed then completed.
2. Complete the following fields:
-Billing Client Number from payment coupon / Client Name
-Policy Number
-Policy Effective Date & Policy Renewal Date
-Determine and select company (FBMIC or WAIC)
-Select EFT Authorization or Credit/Debit Card Authorization
If EFT Authorization:
Check the Authorization box
Select Account Type
Enter Routing Number
Enter Account Number
Enter Desired Withdrawal Date
Sign Form on signature line
Date form on Date line
If Credit/Debit Card Authorization:
Enter VISA/MasterCard Number
Enter Expiration Date
Enter 3 Digit Security Code
Enter Billing Address (if different from policy address)
3. Upon completion of the form, deliver or mail to your Farm Bureau Agent for processing. To find your agent’s mailing address, click the “Find an Agent” link at the top of the page.
1. This form may filled out on your computer prior to printing and signing, or may be printed and then completed.
2. Determine if the vehicle qualifies for the Low Mileage credit by verifying it is driven less than 7,500 miles per year.
3. If the vehicle qualifies for the credit, complete the following information fields:
-Insured’s Name
-Insured’s Address
-Insured’s City, State, and ZIP
-Current Odometer Reading
-Date Odometer Read
4. Upon completion of the form, deliver or mail to your Farm Bureau Agent for application of the Low Mileage Credit, at least 45 days prior to the policy’s renewal date. To find your agent’s mailing address, click the “Find an Agent” link at the top of the page.
-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
If you have any questions call 800-247-4170, Monday - Friday 8:00 am - 4:30 pm CST.