Policy Changes

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Please note, the PS5112 and PS3063 are state specific forms. Due to legal requirements, you must choose the form according to the State law which your policy was issued under. If you are unsure which State law applies to your policy, please contact our Customer Service Center at 1-800-387-2747 or WebMail@jhancock.com for confirmation. If your State of issue is not listed, please select the generic version (PS5112US or PS3063US).

Customer Service forms for products issued by the John Hancock Life Insurance Company and the John Hancock Variable Life Insurance Company can be found on the www.johnhancock.com.

For our return address click here.

Form #		Form Name

PS0011US (11/2006)		US - Acceptance Form
PS5112US (11/2007)		US - Application for Reinstatement
PS5112AZ (11/2007)		AZ - Application for Reinstatement
PS5112CA (11/2007)		CA - Application for Reinstatement
PS5112CO (11/2007)		CO - Application for Reinstatement
PS5112CT (11/2007)		CT - Application for Reinstatement
PS5112DC (11/2007)		DC - Application for Reinstatement
PS5112FL (11/2007)		FL - Application for Reinstatement
PS5112IN (11/2007)		IN - Application for Reinstatement
PS5112MA (11/2007)		MA - Application for Reinstatement
PS5112MD (11/2007)		MD - Application for Reinstatement
PS5112ME (11/2007)		ME - Application for Reinstatement
PS5112MI (11/2007)		MI - Application for Reinstatement
PS5112MN (11/2007)		MN - Application for Reinstatement
PS5112MO (11/2007)		MO - Application for Reinstatement
PS5112MT (11/2007)		MT - Application for Reinstatement
PS5112NC (11/2007)		NC - Application for Reinstatement
PS5112NE (11/2007)		NE - Application for Reinstatement
PS5112NJ (11/2007)		NJ - Application for Reinstatement
PS5112NM (11/2007)		NM - Application for Reinstatement
PS5112NV (11/2007)		NV - Application for Reinstatement
PS5112OH (11/2007)		OH - Application for Reinstatement
PS5112OK (11/2007)		OK - Application for Reinstatement
PS5112PA (11/2007)		PA - Application for Reinstatement
PS5112PR (11/2007)		PR - Application for Reinstatement
PS5112TN (11/2007)		TN - Application for Reinstatement
PS5112UT (11/2007)		UT - Application for Reinstatement
PS5112VA (11/2007)		VA - Application for Reinstatement
PS5112VI (11/2007)		VI - Application for Reinstatement
PS5112VT (11/2007)		VT - Application for Reinstatement
PS5112WA (11/2007)		WA - Application for Reinstatement
PS5112WI (11/2007)		WI - Application for Reinstatement
PS5100US (07/2006)		US - Internal 1035 Rollover/Exchange
PS1656 (01/2005)		US - Option Selection for Matured Policies/Retirement Benefit Election for Qualified Plans
PS3063US (01/2005)		US - Request For Policy Change
PS3063AZ (01/2005)		AZ - Request For Policy Change
PS3063CA (01/2005)		CA - Request For Policy Change
PS3063CO (01/2005)		CO - Request For Policy Change
PS3063CT (01/2005)		CT - Request For Policy Change
PS3063FL (01/2005)		FL - Request For Policy Change
PS3063HI (01/2005)		HI - Request For Policy Change
PS3063IA (01/2005)		IA - Request For Policy Change
PS3063KS (01/2005)		KS - Request For Policy Change
PS3063KY (01/2005)		KY - Request For Policy Change
PS3063LA (01/2005)		LA - Request For Policy Change
PS3063MA (01/2005)		MA - Request For Policy Change
PS3063MD (01/2005)		MD - Request For Policy Change
PS3063ME (01/2005)		ME - Request For Policy Change
PS3063MN (01/2005)		MN - Request For Policy Change
PS3063MO (01/2005)		MO - Request For Policy Change
PS3063MS (01/2005)		MS - Request For Policy Change
PS3063MT (01/2005)		MT - Request For Policy Change
PS3063ND (01/2005)		ND - Request For Policy Change
PS3063NJ (01/2005)		NJ - Request For Policy Change
PS3063NM (01/2005)		NM - Request For Policy Change
PS3063OH (01/2005)		OH - Request For Policy Change
PS3063OK (01/2005)		OK - Request For Policy Change
PS3063OR (01/2005)		OR - Request For Policy Change
PS3063PA (01/2005)		PA - Request For Policy Change
PS3063SC (01/2005)		SC - Request For Policy Change
PS3063TN (01/2005)		TN - Request For Policy Change
PS3063TX (01/2005)		TX - Request For Policy Change
PS3063UT (01/2005)		UT - Request For Policy Change
PS3063VA (01/2005)		VA - Request For Policy Change
PS3063VT (01/2005)		VT - Request For Policy Change
PS3063WI (01/2005)		WI - Request For Policy Change
PS3063WV (01/2005)		WV - Request For Policy Change
PS5127US (11/2007)		US - Statement of Lost Policy


Insurance products issued by: John Hancock Life Insurance Company (U.S.A.), Boston, MA 02116.