Fillable Va Form 29-1549 - Application For Change Of Permanent Plan (Medical) printable pdf download

OMB Control No. 2900-0179

Respondent Burden: 30 Mins.

(For Use of VA Index)

APPLICATION FOR CHANGE OF PERMANENT PLAN

(MEDICAL)

(CHANGE TO A POLICY WITH A LOWER RESERVE VALUE)

PRIVACY ACT INFORMATION: VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of

1974 or Title 5, Code of Federal Regulations 1.526 for routine uses identified in VA system of records, 36VA00, Veterans and Armed Forces Personnel U. S. Government

Life Insurance Records - VA, and published in the Federal Register. Your obligation to respond is required to obtain or retain benefits. The responses you submit are

considered confidential (38 USC 5701).

RESPONDENT BURDEN: We need this information to verify your eligibility to change your permanent plan (38 U.S.C. 5902). Title 38, United States Code, allows us to

ask for this information. We estimate that you will need an average of 30 minutes to review the instructions, find the information and complete this form. VA cannot

conduct or sponsor a collection of information unless a valid OMB Control Number is displayed. You are not required to respond to a collection of information if this

number is not displayed. Valid OMB Control Numbers can be located on the OMB Internet Page at: If

desired, you can call 1-800-827-1000 to get information on where to send your suggestions or comments about this form.

INSTRUCTIONS

This form is used to change a permanent plan of Insurance to another permanent plan with a lower reserve value.

The difference between the reserve of the two plans may be applied to a policy loan, applied to future premiums, or refunded to you in

cash.

REQUIREMENT: You must be in good health to change to a plan with a lower reserve value. Please complete all the health questions

on the back of this form.

The beneficiary and/or optional settlement under the new policy will remain the same as under the old policy. If a change is desired,

submit VA Form 29-336, Designation of Beneficiary - Government Life Insurance.

It is not possible to change from a permanent plan to Term Insurance. Call our toll-free number for information on the available plans.

Department of Veterans Affairs

Complete and return this form to the following address:

Regional Office and Insurance Center (COP)

P. O. Box 7208

Philadelphia, PA 19101

PART I - STATEMENT OF APPLICATION

1. FIRST NAME - MIDDLE NAME - LAST NAME OF INSURED

(Include letter prefix)

2. INSURANCE FILE NUMBER

3. MAILING ADDRESS

4. SOCIAL SECURITY NUMBER

(If any)

6. DAYTIME TELEPHONE NUMBER

5. VA FILE NUMBER

7. POLICY NUMBER

8. AMOUNT OF INSURANCE

9. PLAN OF INSURANCE

10. DO YOU WISH TO CONTINUE OR ADD THE

APPLIED FOR

TOTAL DISABILITY INCOME PROVISION

YES

11. DISPOSITION OF RESERVE CREDIT

PAY FUTURE PREMIUMS

APPLY TO INDEBTEDNESS

PAY IN CASH

12. METHOD OF PREMIUM PAYMENT

MONTHLY ALLOTMENT FROM SERVICE PAY

DIRECT PAYMENT TO VA

(Complete Item 13)

MONTHLY DEDUCTION FROM YOUR CHECKING ACCOUNT

MONTHLY DEDUCTION FROM VA BENEFIT CHECK

13. MODE OF PREMIUM PAYMENT

MONTHLY

QUARTERLY

SEMI-ANNUALLY

ANNUALLY

IF YOU HAVE ANY QUESTIONS ABOUT YOUR INSURANCE CALL TOLL FREE 1-800-669-8477.

VA FORM

EXISTING STOCKS OF VA FORM 29-1549, JUL 2001,

29-1549

MAR 2008

WILL BE USED.

Va Form 29-1549 - Application For Change Of Permanent Plan (Medical)

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