$xforms-template-label$$xforms-template-help$$xforms-template-hint$$xforms-template-label$$xforms-template-help$$xforms-template-hint$

Your browser does not appear to support JavaScript. You may want to try one of the following:

Turn on JavaScript in your browser if it supports it.
Use a browser that supports JavaScript.
Try a JavaScript-free version of this page, if made available by the application author.

An error has occurred

You may want to try one of the following:

Close this dialog and continue to use this page.
Reload this page. Note that you will lose any unsaved changes.
If the above does not work, try reloading the page yourself. Note that you will lose any unsaved changes:
- With Firefox: hold down the shift key and click the Reload button in your browser toolbar.
- With Safari and Chrome: click the Reload button in your browser toolbar.
- With Internet Explorer: hold down the control key and click the Reload button in your browser toolbar.
Return home.

Reloading form

This form has to be reloaded. This most likely happened because your session has expired, which might take you to the login page. (If you think that you shouldn't see this message and that the problem persists, please contact support.)

Help

Full Surrender Portal

No further action required.

Colorado Bankers Life Insurance Company Change of Address Form

CBL Change of Address Form.pdf 475 KB

Drag files here or use the button below. Remove File

Remove File

Select File

Bankers Life Insurance Company Change of Address Form

BLIC Change of Address Form.pdf 478 KB

Drag files here or use the button below. Remove File

Remove File

Select File

06bfee34b73ff097da498371fd7d55135b53f1d9

Confirm

Form Submitted

Review Form Validation Messages

Unable to complete action

Confirmation