1.  Use this form to:

     -Change or update your beneficiary

     -Add a contingent beneficiary

2.  Print the form, complete and sign it.

3.  If any designations are trusts, please send a copy of the first page following the cover page and the signature page of the trust document with your form.

4.  Fax your completed form to 800-754-6370 OR

     Mail to: Farm Bureau Life, PO Box 9168, Des Moines, IA 50306

5.  Your form will be processed upon receipt. We will contact you if additional  information is needed.

Note: Please do not save blank copies of these forms as they are periodically updated. Always return to the Web site to get the most current version.

If you have any questions call 800-247-4170, Monday – Friday 8:00 am – 4:30 pm CST.

1.    This form may be filled out on your computer prior to printing and signing, or may be printed then completed.

2.    Complete the following fields:

     -Billing Client Number from payment coupon / Client Name

     -Policy Number

     -Policy Effective Date & Policy Renewal Date

     -Determine and select company (FBMIC or WAIC)

     -Select EFT Authorization or Credit/Debit Card Authorization

If EFT Authorization:

Check the Authorization box

Select Account Type

Enter Routing Number

Enter Account Number

Enter Desired Withdrawal Date

Sign Form on signature line

Date form on Date line

If Credit/Debit Card Authorization:

Check the Authorization box

Enter VISA/MasterCard Number

Enter Expiration Date

Enter 3 Digit Security Code

Enter Billing Address (if different from policy address)

Sign Form on signature line

Date form on Date line

3.    Upon completion of the form, deliver or mail to your Farm Bureau Agent for processing. To find your agent’s mailing address, click the “Find an Agent” link at the top of the page.

Note: Please do not save blank copies of these forms as they are periodically updated. Always return to the Web site to get the most current version.

If you have any questions, please contact your agent or call 866-399-3237, Monday - Friday 7:30 am - 6:00 pm CST.

1.    This form may be filled out on your computer prior to printing and signing, or may be printed and then completed.

2.    Determine if the rated youthful operator qualifies for the Good Student Credit by reviewing the eligibility guidelines listed on the verification form.

3.    If the youthful operator qualifies for the credit, complete the following information fields:

-Personal Package Policy #

-Policy Renewal Date

-Vehicle Year

-Vehicle Make

-Vehicle Model

-Vehicle Identification Number (VIN)

-Rated Youthful Driver

4.    Upon completion of the form, deliver or mail to your Farm Bureau agent for application of the Good Student Credit, at least 30 days prior to the policy’s renewal date. To find your agent’s mailing address, click the “Find an Agent” link at the top of the page.

Note: Please do not save blank copies of these forms as they are periodically updated. Always return to the Web site to get the most current version.

If you have any questions, please contact your agent or call 866-399-3237, Monday - Friday 7:30 am - 6:00 pm CST.

1.  Use this form to:

     -Set up automatic monthly withdrawals from your bank account to pay premiums

     -Change the bank account where your premiums are currently being withdrawn

     -Be sure to attach avoided check

     -The form must be signed by the bank account owner

2.  Print the form, complete and sign it.

3.  Fax your completed form to 800-754-6370 OR

     Mail to: Farm Bureau Life, PO Box 9168, Des Moines, IA 50306

4.  Your form will be processed upon receipt. We will contact you if additional  information is needed.

Note: Please do not save blank copies of these forms as they are periodically updated. Always return to the Web site to get the most current version.

If you have any questions call 800-247-4170, Monday - Friday 8:00 am - 4:30 pm CST.

1.  Use this form to automatically deposit funds into a specific financial institution.

2.  Print the form, complete and sign it.

3.  Fax your completed form to 800-754-6370 OR

     Mail to: Farm Bureau Life, PO Box 9168, Des Moines, IA 50306

4.  Your form will be processed upon receipt. We will contact you if additional  information is needed.

Note: Please do not save blank copies of these forms as they are periodically updated. Always return to the Web site to get the most current version.

If you have any questions call 800-247-4170, Monday – Friday 8:00 am – 4:30 pm CST.

1.  Use this form to:

     -Dollar Cost Average

     -Interest Sweep

     -Automatic Rebalancing

     -Systematic Withdrawal

2.  Print the form, complete and sign it.

3.  Fax your completed form to 800-754-6370 OR

     Mail to: Farm Bureau Life, PO Box 9168, Des Moines, IA 50306

4.  Your form will be processed upon receipt. We will contact you if additional  information is needed.

Note: Please do not save blank copies of these forms as they are periodically updated. Always return to the Web site to get the most current version.

If you have any questions call 800-247-4170, Monday – Friday 8:00 am – 4:30 pm CST.

1.  Use this form to:

     -Make changes on your policy such as

ü       Address

ü       Name

ü       Premium payments

ü       Dividend options

     -Request a loan

     -Transfer ownership

     -Request a dividend withdrawal

     -Request a partial withdrawal on a universal life plan

     -Request surrender of the policy

2.  Print the form, complete and sign it.

3.  Fax your completed form to 800-754-6370 OR

     Mail to: Farm Bureau Life, PO Box 9168, Des Moines, IA 50306

4.  Your form will be processed upon receipt. We will contact you if additional  information is needed.

Note: Please do not save blank copies of these forms as they are periodically updated. Always return to the Web site to get the most current version.

If you have any questions call 800-247-4170, Monday – Friday 8:00 am – 4:30 pm CST.

1.   This form may filled out on your computer prior to printing and signing, or may be printed and then completed.

2.   Determine if the vehicle qualifies for the Low Mileage credit by verifying it is driven less than 7,500 miles per year.

3.   If the vehicle qualifies for the credit, complete the following information fields:

-Insured’s Name

-Insured’s Address

-Insured’s City, State, and ZIP

-Personal Package Policy #

-Policy Renewal Date

-Vehicle Year

-Vehicle Make

-Vehicle Model

-Vehicle Identification Number (VIN)

-Current Odometer Reading

-Date Odometer Read

4.   Upon completion of the form, deliver or mail to your Farm Bureau Agent for application of the Low Mileage Credit, at least 45 days prior to the policy’s renewal date. To find your agent’s mailing address, click the “Find an Agent” link at the top of the page.

Note: Please do not save blank copies of these forms as they are periodically updated. Always return to the Web site to get the most current version.