Manage your policies & download forms
Manage your policies online
Sign up today to manage your life insurance policies. Once you're registered, you'll have the ability to:
- Pay your bill
- View policy information
- Request policy changes
Online service forms
For your convenience, find the service form you need from the drop-down menus below. Complete, sign and date the form and return it to Liberty Life for processing.
Liberty Life Assurance Company of Boston
Service Center - MS 03B
100 Liberty Way
Dover NH, 03820
Fax: 1-603-749-9759
Or, you can scan a copy of the completed form and email to: Life-PHS-Support@LibertyMutual.com
For information regarding your coverage, beneficiaries, loans or contract credits/dividend options, please contact Policyholder Services at 1-800-451-7065 Monday through Friday, 8:00 a.m. to 6:00 p.m. Eastern Time.
Electronic Payment Authorization (PAC/EFT)
Complete this form to set-up or change your automatic deduction from your bank account to pay your life insurance premiums.
Download Form (PDF) (PLA-2005144 Rev 08/07)
Contract Change Request
Complete this form to change a name, address, policy owner, payor, or to request a withdrawal or loan from your policy.
Download Form (PDF) PLA-2005142 Rev 04/08
Beneficiary Change Request
Complete this form to change the beneficiary of a contract.
Download Form (PDF) PLA-2005143 Rev 08/08
Authorization to Release Contract Information
Complete this form to authorize Liberty Life Assurance Company of Boston (Liberty Life) to release all contract information regarding your contract to the designated Information Assignee(s). This authorization will allow the Information Assignee(s) to make telephone payment(s) on behalf of the contract payor.
Download Form (PDF) PLA-2007029 Rev 04/07
Verification of Trust
Complete this form to verify a trust.
Download Form (PDF) PLA-2005006 Rev 01/05
Collateral Assignment
Complete this form to transfer a contract as security.
Download Form (PDF) PLA-7047 Rev 07/05
IRS W-9 Request for Taxpayer ID Number and Certification
Complete this form to certify your Social Security Number/Taxpayer ID Number with Liberty Life.
Download Form (PDF)
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