×
Existing Dealers and Agents Log In Here.
Log In

Customer Forms

The forms listed below are available for download in Adobe PDF format. If you are unable to open the PDF files below, you will need to download and install the free Adobe Acrobat PDF Reader.

Our forms include:

Transfer Form
Cancellation Form
Cancellation FAQs 

To cancel your coverage, simply click on the "Cancellation Form" link, print the form, fill out the requested information including signature, and return the form to the selling dealer or program administrator listed on the contract for refund processing.

Cancellation Form
Cancellation FAQs 
Privacy Notice

To cancel your coverage, simply click on the "Cancellation Form" link, print the form, fill out the requested information including signature, and return the form to the selling dealer or program administrator listed on the contract for refund processing.

Credit Life Insurance Claim Form
New York Credit Life Insurance Claim Form
Credit Disability Insurance Claim Form
Third Party Authorization Form
W-9 Packet

To cancel your credit life and/or disability insurance, please contact the program administrator at 800.841.4777 or contact the selling dealer.

Transfer Form
Cancellation Form



To cancel your coverage, simply click on the "Cancellation Form" link, print the form, fill out the requested information including signature, and return the form to the selling dealer or program administrator listed on the contract for refund processing.

Premium Marine Protection Maintenance Tips - PDF Version
Premium Marine Protection Maintenance Tips - Audio Version

Transfer Form
Cancellation Form
Cancellation FAQs 

To cancel your coverage, simply click on the "Cancellation Form" link, print the form, fill out the requested information including signature, and return the form to the selling dealer or program administrator listed on the contract for refund processing.

Transfer Form
Cancellation Form


To cancel your coverage, simply click on the "Cancellation Form" link, print the form, fill out the requested information including signature, and return the form to the selling dealer or program administrator listed on the contract for refund processing.

© 2017 Protective Life Corporation