If you are an existing policyholder, you may wish contact us by phone for faster service. (Click here for phone numbers.) Otherwise, please complete the form below. Please note that under no circumstances can we accept transactions like address changes, premium payments, cancellations, etc. through this form.

1. *Required information


2. First Name: *


3. Last Name: *


4. Who are you? * – Select – Existing Customer Agent / Producer Other


5. What is the nature of your request? * – Select –Premium Payment InformationContract / Policy ChangesDuplicate Policy RequestOther InquiryFeedback & Comments


6. What kind of product are you inquiring about? * – Select –AnnuityLifeLong Term Care InsuranceOther


7. Phone Number: *
   Please include area code


8. Email Address: *



9. To safeguard your information, please do not include the following information in your comments:
   
   
   
   • Contract / policy numbers
   
   
   • Social security numbers
   
   
   • Your username or password



10. Comments:


11. Please limit your comment to 500 characters or less. (0 characters remaining)


12. I started surrender of policy August 2nd 2011. I need to verify my request is processing. conflicting info from phone conversations concerning my social security number requirement. Please contact asap! maryjeanziska@mysearchforjustice.com. and please review my blog post for complete detailed info on contact with your company. website: <a href="http://www.mysearchforjustice.com">www.mysearchforjustice.com</a><br /> blog post: (august 16th @2:43am(Genworth life surrender of policy…problems) thank you for your kind attention to this email.