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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:

  1. Print the form, complete and sign it.
  2. Fax or mail the form as stated in the instructions listed next to the form.
  3. 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

    The Beneficiary Designation form is now part of the fillable & smart PSR form. The non-fillable Beneficiary Designation form can still be printed from the Toolkit.

    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.

  • 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    -Change the bank account where your premiums are currently being withdrawn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.
  • Dollar Cost Averaging - Automatic Rebalancing - Interest Sweep - Systematic Withdrawal

    1. Use this form to:

    -Dollar Cost Average

    -Interest Sweep

    -Automatic Rebalancing

    -Systematic Withdrawal

    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.

  • 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.

  • 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

    -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.

  • 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.

  • 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.

Auto/Home/Property Policy Forms
  • Electronic Funds Transfer Form (EFT)

    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:

    Check the Authorization box

    Enter VISA/MasterCard Number

    Enter Expiration Date

    Enter 3 Digit Security Code

    Enter Billing Address (if different from policy address)

    Sign Form on signature line

    Date form on Date line

    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.

    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, please contact your agent or call 866-399-3237, Monday - Friday 7:30 am - 6:00 pm CST.

  • Good Student Credit Form

    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 vehicle qualifies for the Good Student Credit by verifying that the driver is a full time student with a qualifying scholastic record during the immediate preceeding school semester/quarter.

    3. If the vehicle 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)

    4. Upon completion of the form, deliver or mail to your Farm Bureau Agent along with a copy of the rated youthful driver's most recent grade transcript for application of the Good Student 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.

  • Low Mileage Discount Form

    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

    -Personal Package Policy #

    -Policy Renewal Date

    -Vehicle Year

    -Vehicle Make

    -Vehicle Model

    -Vehicle Identification Number (VIN)

    -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.

    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, please contact your agent or call 866-399-3237, Monday - Friday 7:30 am - 6:00 pm CST

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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