Records Authorization—Life Insurance
I, [name], authorize [name of company] Life Insurance Company to release all life insurance records concerning policy number[s] [number[s]] to [name] and the law firm of [name of law firm]. This authorization specifically includes:
1.Names of beneficiaries.
2.Loans made against the policies and the loan balances.
3.Cash surrender value.
4.Amounts of premiums and if premiums are current.
5.Date or dates of purchase.
6.Full name of insured.
7.Changes in beneficiary or requests for changes.
8.Face value of each policy.
9.Owner of each policy.
I authorize reliance on a photocopy of this authorization.
[Name]
Social Security number [number]
State of Texas)
County of)
This instrument was acknowledged before me on __________________________ by [name of person acknowledging].
Notary Public, State of Texas