Forms

Online Service Forms

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  For your convenience, find the service form you need from the list 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) (PDF)
  • Contract Change Request (PDF)
  • Beneficiary Change Request (PDF)
  • Authorization to Release Contract Information (PDF)
  • Verification of Trust (PDF)
  • Collateral Assignment (PDF)
  • IRS W-9 Request for Taxpayer ID Number and Certification (PDF)

  Contact Customer Service

  Life insurance and annuities issued by:
  Liberty Life Assurance Company of Boston, a Liberty Mutual company
  Home office: Boston, Mass. Service center: Dover, N.H.

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