Forms Library

NJ Buyers Guide (Auto)
Whether you are buying a new insurance policy or renewing your current policy, you must make many decisions about what coverage you need and how much you can pay. The following guide outlines how to make choices that work for you.

New Jersey Auto Insurance Buyers Guide

NJ Bill of Rights (Auto)
Auto insurance is required in New Jersey. As a New Jersey driver, you have many choices when it comes to purchasing auto insurance. Each choice you make affects the coverage you receive and the amount you pay.

Automobile Insurance Consumer Bill of Rights

Electronic Payment Authorization Forms
Tired of mailing your insurance payment every month? Simplify and go green! We offer two monthly electronic payment options that are safe, secure, and convenient. Plus, they’re better for the environment.

ExpressIT^®
We will automatically deduct the amount due from your checking/savings account each month. You may even receive a discount with this plan!

ExpressIT Authorization Form

Recurring Credit Card
We will charge your credit card each month for the amount due. We accept Visa, MasterCard, Discover, and American Express. PAK II policies are not eligible for this payment plan.

Monthly Recurring Credit Card Authorization Form

Enroll Now
Download and complete the appropriate form above. Don’t forget to sign it. Then fax it to us at the number listed on the form. It’s that simple! Please allow 15 business days to process this change.

Download and complete the appropriate form below. Then mail or fax it to us at the address or number provided.

Mail form to:
MetLife
PO Box 10342
Des Moines, IA 50306 - 0342
Fax: 1-877-547-9669

Change of Beneficiary
Use this form to correct, change or designate your beneficiaries.
PDF version (52k)

Change Owner’s Name or Contact Information 
Use this form to correct or update an Owner's name, address, or phone number. This form is not to be used for changes in ownership, which requires a policy service request form.
PDF version (52k)

Annuity Withdrawal Form
Use this form if your account is eligible for withdrawals.
PDF version (52k)

Required Minimum Distribution (RMD) Form 
This form is to be used to request a Required Minimum Distribution (RMD) for a MetLife annuity. 
PDF version (52k)

Death Claim
This form should be used for a death claim for a variable or fixed annuity contract, non-Qualified, Traditional, SEP, Simple or Roth IRA annuity account. The form contains a description of the claim process.
PDF version (845k)

Agent Change
Use this form to change broker of record.
PDF version (906k)

3rd Party Authorization
Use this form to authorize an individual's access for 1 year to an owner’s account.
PDF version (723k)

EFT Enrollment
Use this form to establish or modify banking information on file.
PDF version (368k)

For additional forms please visit 
https://eforms.metlife.com

Download and complete the appropriate form below. Then mail or fax it to us at the address or number provided.
Mail form to: 
MetLife 
PO Box 10356 
Des Moines, IA 50306 - 0356
Fax: 1-877-549-5834

Change of Beneficiary
Use this form to correct, change or designate your beneficiaries. 
PDF version (52k)

Make Corrections to Group Participant Information
This form is for use by an Administrator to change Group Participant information (e.g., name changes, deletions, corrects, etc.). 
PDF version (52k)

403(b) Withdrawal Request Form - Non-ERISA
This form is for a participant or alternate payee to request a distribution from a 403(b) Non-ERISA annuity other than for a hardship or as a systematic withdrawal.
PDF version (52k)

403(b) Beneficiary Change
Use this form for a change of Beneficiary and Spousal Consent for ERISA or Non-ERISA 403(b). 
PDF version (52k)

For additional forms please visit
https://eforms.metlife.com

Dental Claim Form
We recommend that you bring a claim form with you when you visit your dentist for an appointment.
PDF version (193k)

Mail Above form to:
MetLife Dental Claims
PO Box 981282
El Paso, TX 79998-1282

Medical Authorization/Disclosure of Information
Use the form to inform your physician(s) that MetLife will be administering your disability claim and give authorization to release your medical information to MetLife. 
PDF Version (41k)

Mail Above form to: 
Metropolitan Life Insurance Company 
Attn: MetLife Disability Claims 
PO Box 14590 
Lexington, KY 40511-4590 
Fax: 1-800-230-9531

Attending Physician Statement
This form is used to gather medical information necessary for the ongoing management of disability claims. Have your physician complete this form when your case manager requests new/updated medical information.
PDF version (237k)

Mail Above form to: 
Metropolitan Life Insurance Company 
Attn: MetLife Disability Claims 
PO Box 14590 
Lexington, KY 40511-4590 
Fax: 1-800-230-9531

Health Care Provider Certification-FMLA
These forms are used to gather medical information necessary for the ongoing management of Family and Medical Leave Act (FMLA) Claims for yourself, a family member or a service-member family member. Have the physician complete this form after you file your claim. 

Certification for Employee's Serious Health Condition
Certification for Family Member's Serious Health Condition
Certification for Qualifying Exigency for Military Family Leave
Certification for Covered Service-member for Military Family Leave

Mail Above form to: 
Metropolitan Life Insurance Company 
Attn: MetLife Disability Claims 
PO Box 14590 
Lexington, KY 40511-4590 
Fax: 1-800-230-9531

Electronic Funds Transfer (EFT) Authorization Form
Complete, sign and mail/fax this form to MetLife to authorize electronic funds transfers of your disability insurance payments directly to your bank. Please verify that your employer's plan offers electronic funds transfer for disability income benefit payments before submitting this form to MetLife.
PDF version (41k)

Mail Above form to: 
Metropolitan Life Insurance Company 
Attn: MetLife Disability Claims 
PO Box 14590 
Lexington, KY 40511-4590 
Fax: 1-800-230-9531

Individual Life Death Claim
On behalf of MetLife, please accept our sincere condolences during this difficult time.  We'll try to make the process of filing a life insurance claim as simple as possible.For each beneficiary, please complete and return one of the forms below.

• If the beneficiary is an individual, use this form. 
• If the beneficiary is a trust or entity, use this form.

Online Service
If you would like to perform service transactions online, please register or log in to eSERVICE. 

Change of Beneficiary Form
Change the beneficiary of your policy with this easy to use form. 
PDF version (340 KB)

Electronic Payment (EP) Account Agreement
Pay your premiums and make other transactions with our convenient Electronic Payment (EP) Account Agreement. Use this form to authorize electronic fund transfers from your checking, savings or share draft account to pay premiums due on your personal life insurance policies. The form contains detailed instructions on how to use this convenient service.
PDF version (605 KB)

Policy Surrender Form
This form is used to request a full cash surrender on your life insurance policy. 
PDF version (237 KB)

Request a Loan Form
This form is used to request a loan on your life insurance policy.
PDF version (250 KB)

Partial Withdrawal Form
This form is used to request a partial withdrawal from a universal life policy. 
PDF version (246 KB)

Dividend Withdrawal Form
This form is used to request a withdrawal of dividend or riders from a traditional life insurance policy.
PDF version (247 KB)

For all other forms, please contact a customer service representative at 800-638-5000.

Visit www.metlife.com/ltc/documents to find frequently used forms to service your Long-Term Care policy.

TCA – Beneficiary Designation Form
To add or change beneficiaries on your Total Control Account.
PDF version (50k)

Mail form to:
Metropolitan Life Insurance Company
Total Control Account
PO Box 6300
Scranton, PA 18505-6300

Change Accountholder’s Name or Address of Record
To change or correct TCA Accountholder name and address.
PDF version (52k)

Mail form to:
Metropolitan Life Insurance Company
Total Control Account
PO Box 6300
Scranton, PA 18505-6300

TCA Death of Accountholder Standard Claim Form
To make a claim for benefits upon the death of a TCA Accountholder, or to replace a claim form previously sent to you by MetLife upon the death of a TCA Accountholder. 

(Use the Standard Claim Form if the Accountholder DID NOT reside in MN or NY at the time of death, or if the beneficiary DOES NOT reside in AK, FL, LA, MN, or NY. Please call 800-638-7283 for questions.)
PDF version (52k)

Mail form to:
Metropolitan Life Insurance Company
Total Control Account
PO Box 6300
Scranton, PA 18505-6300

TCA Death of Accountholder Elective Claim Form
To make a claim for benefits upon the death of a TCA Accountholder, or to replace a claim form previously sent to you by MetLife upon the death of a TCA Accountholder. 

(Use the Elective Claim Form when the Accountholder resided in MN or NY at the time of death, or if the beneficiary resides in AK, FL, LA, MN, or NY. Please call 800-638-7283 for questions.)
PDF version (52k)

Mail form to:
Metropolitan Life Insurance Company
Total Control Account
PO Box 6300
Scranton, PA 18505-6300

MetLife Claim Form 
In English PDF Version (161k) 
En Español PDF Version (163k)

SafeGuard Grievance Forms 
California Dental/Vision Grievance Form PDF Version (173k) 
Florida Dental/Vision Grievance Form PDF Version (263k) 
New Jersey Dental/Vision Grievance Form PDF Version (234k) 
New York Dental/Vision Grievance Form PDF Version (18k) 
Texas Dental/Vision Grievance Form PDF Version (268k)