Nationwide life insurance forms & applications

Find the form or application you need for your Nationwide life insurance policy. Then, print it and mail it to the address on the form.

Get forms for making account updates, application requests and more

Make account updates, including:

Name
Address
Dividend options
Billing mode
Planned periodic premium

Get application requests for:

Policy loan options
Partial surrender options
Dividend withdrawal amount
Method of distribution
Federal tax withholding information
Taxpayer ID certification

More forms for all accounts:

Application for change of beneficiary designation
Duplicate policy request

Set up or change recurring payments from your bank account
Recurring Automated Clearing House (ACH) Authorization

Important information for residents of Kentucky, Maine, Oregon and Washington

Get definitions of commonly used insurance terms and related information for your state.

Required information for Kentucky residents
Required information for Maine residents

Required information for Oregon residents
Required information for Washington residents

How to buy long-term care coverage

You need to work with an insurance professional to buy this type of product. If you don't have one, our life insurance specialists are here to help.

Give us a call today at 1-855-863-9639 for a no-obligation consultation.

Hours of operation are 9 a.m. to 8:30 p.m. ET, Monday through Friday.

1-877 On Your Side (1-877-669-6877)

• Not a deposit • Not FDIC or NCUSIF insured • Not guaranteed by the institution • Not insured by any federal government agency • May lose value

This material is not a recommendation to buy or sell a financial product or to adopt an investment strategy. Investors should discuss their specific situation with their financial professional.

Life and annuity products are issued by Nationwide Life Insurance Company or Nationwide Life and Annuity Insurance Company, Columbus, Ohio. The general distributor for variable products is Nationwide Investment Services Corporation (NISC), member FINRA, Columbus, Ohio. The Nationwide Retirement Institute is a division of NISC. Nationwide Funds are distributed by Nationwide Fund Distributors, LLC, Member FINRA, Columbus, OH. Nationwide Life Insurance Company, Nationwide Life and Annuity Company, Nationwide Investment Services Corporation and Nationwide Fund Distributors are separate but affiliated companies.

The Nationwide Group Retirement Series includes unregistered group fixed and variable annuities issued by Nationwide Life Insurance Company. It also includes trust programs and trust services offered by Nationwide Trust Company, FSB.

Nationwide, the Nationwide N and Eagle, Nationwide is on your side and Nationwide Retirement Institute are service marks of Nationwide Mutual Insurance Company.