(public)
Instructions for Fillable Forms

These pages are intended to assist licensed insurance producers in the sale and service of Phoenix products and are not intended for unassisted use by Phoenix customers. Phoenix customers should go here for Customer Service information.

Forms are an essential part of our business. To help, we've made some of our forms fillable: You click on fields in the form, type the information, then print the completed form.

Tips on Using Fillable Forms

  • The symbol indicates that a form is fillable.
  • Use the Tab key to move through the fillable fields. You also can use your mouse to move to a field and then click on it to activate the field.
  • A small red box with an exclamation mark (!) indicates a "pop up" information box. Hold your mouse over the box to read the message.
  • Enter phone numbers with area code and no punctuation. The form automatically formats.
  • Enter Social Security numbers with no punctuation or spaces. The form automatically formats.
  • A green tab button will bring you to next page.
  • Use the Enter key to make a check mark.
  • When finished, tab out of the field. (Otherwise, the form won't print.)

37308 2-12

©2001-2014 The Phoenix Companies, Inc.

Insurance and annuities issued by Phoenix Life Insurance Company (PLIC) (East Greenbush, NY), PHL Variable Insurance Company (PHLVIC) (Hartford, CT) and Phoenix Life and Annuity Company (PLAC) (Hartford, CT). PHLVIC is not authorized to conduct business in NY and ME. PLAC is not authorized to conduct business in CA, GA, MA, ME, MN, NH, and NY and not authorized to conduct variable universal life insurance business in ID and LA. The insurers referenced are separate entities and each is responsible only for its own financial condition and contractual obligations.

Securities distributed by 1851 Securities, Inc. (Hartford, CT), member FINRA.

Members of The Phoenix Companies, Inc.

Not all products and services described here are available in all states of the USA.