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Great Western Insurance Company

Final Expense insurance forms

You will need to submit forms in order to allow us to perform an array of tasks on your Final Expense insurance policies through Great Western Insurance Company. If a form you need is not listed below, please call 800-733-5454.

Authorization for the use and disclosure of information

Use this form to grant permission to release information to individuals.

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Proof of death claim form

Use this form to disclose a covered person's death. Contact customer care for claim information.

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Absolute assignment

Use this form to change the ownership of your policy. Do NOT use it to assign benefits to others.

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Beneficiary designation

Use this form to designate or change the beneficiaries on your Final Expense policy.

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Accelerated benefit request

Use this form to request the accelerated death benefit for your Final Expense policy.

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Request for service

Use this form to update your name, address, and beneficiary or request a duplicate policy.

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Cash surrender value request

Use this form if you'd like to cancel or surrender your policy in exchange for its cash value.

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Policy loan agreement

Use this form if you would like to request a loan against the value of your policy.

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Automatic premium withdrawal

Use this form to authorize premium payments through bank draft and update your account.

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