Request For Duplicate Policy

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You must call Customer Service at (800) 756-7306 to make a $5.00 processing fee payment after submitting this form.
You will be required to upload a form of identification (Texas Driver’s License, Texas Identification Card, U.S. Passport). If you do not have one of the acceptable forms of identification, please wait until you have them before proceeding with this Sign-Up process.

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Policy Owner Name* This field is required.

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Policy Owner Email

example@example.com

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Policy Number* This field is required.

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Name of Insured* This field is required.

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DECLARATION OF LOST POLICY/REQUEST FOR DUPLICATE POLICY* This field is required.STATE REASON: I hereby certify that the above-referenced policy issued by Texas Service Life Insurance Company has been lost or destroyed under the following circumstances:

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Please Upload a Copy of Your Identification

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Max. file size: 10.6MB

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And that no person(s), partnership, corporation or other entity has any claim or interest in said policy or its benefits by virtue of any gift, sale assignment, pledge, property settlement, divorce or other court action. Based on the foregoing statements, I hereby request issuance of a duplicate policy or that Texas Service Life Insurance Company grant the benefits under the policy, and agree to indemnify and hold harmless Texas Service Life Insurance Company from any and all losses which it may incur as a result of granting this request. It is further agreed that if the original policy is found, the duplicate policy will be returned to Texas Service Life Insurance Company. This indemnification will be binding on my heirs, executors, administrators, successors and assignees. I UNDERSTAND the duplicate policy will not be issued until this request and the $5.00 fee is received, approved and recorded by Texas Service Life Insurance Company.* This field is required.

Accepted

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POLICY OWNER SIGNATURE* This field is required.

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DATE

Date

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What Happens Next?

Please press 'Submit' at the bottom of this card to submit your request.
Call Customer Service at (800) 756-7306 to make your $5.00 processing fee payment.
Please allow (2) business days for the processing of this request.
If you have any questions after submitting your form and payment, please email us at CUSTOMERSERVICE@TSLIC.COM.