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 In Force Life Insurance products issued by John Hancock can be found on www.johnhancock.com.

For our return address click here.

Please note: If you are requesting a reduction to the Face Amount to your policy that a pro-rata surrender charge may apply to policy value. Please contact customer service to discuss this with one of our representatives.

Form #		Form Name

PS5112US (01/2010)		US - Application for Reinstatement
PS5112AZ (01/2010)		AZ - Application for Reinstatement
PS5112CA (01/2010)		CA - Application for Reinstatement
PS5112CO (01/2010)		CO - Application for Reinstatement
PS5112CT (01/2010)		CT - Application for Reinstatement
PS5112DC (01/2010)		DC - Application for Reinstatement
PS5112FL (01/2010)		FL - Application for Reinstatement
PS5112IN (01/2010)		IN - Application for Reinstatement
PS5112MA (01/2010)		MA - Application for Reinstatement
PS5112MD (01/2010)		MD - Application for Reinstatement
PS5112ME (01/2010)		ME - Application for Reinstatement
PS5112MI (01/2010)		MI - Application for Reinstatement
PS5112MN (01/2010)		MN - Application for Reinstatement
PS5112MO (01/2010)		MO - Application for Reinstatement
PS5112MT (01/2010)		MT - Application for Reinstatement
PS5112NC (01/2010)		NC - Application for Reinstatement
PS5112NE (01/2010)		NE - Application for Reinstatement
PS5112NJ (01/2010)		NJ - Application for Reinstatement
PS5112NM (01/2010)		NM - Application for Reinstatement
PS5112NV (01/2010)		NV - Application for Reinstatement
PS5112OH (01/2010)		OH - Application for Reinstatement
PS5112OK (01/2010)		OK - Application for Reinstatement
PS5112PA (01/2010)		PA - Application for Reinstatement
PS5112PR (01/2010)		PR - Application for Reinstatement
PS5112TN (01/2010)		TN - Application for Reinstatement
PS5112UT (01/2010)		UT - Application for Reinstatement
PS5112VA (01/2010)		VA - Application for Reinstatement
PS5112VI (01/2010)		VI - Application for Reinstatement
PS5112VT (01/2010)		VT - Application for Reinstatement
PS5112WA (01/2010)		WA - Application for Reinstatement
PS5112WI (01/2010)		WI - Application for Reinstatement
PS5100US(04/2009)		US - Internal 1035 Rollover/Exchange
PS1656US (01/2010)		US - Option Selection for Matured Policies/Retirement Benefit Election for Qualified Plans
PS5147US (01/2010)		US - Policy Change Form No Underwriting Required
PS5148AK (01/2010)		AK - Policy Change Form Underwriting Required
PS5148AL (01/2010)		AL - Policy Change Form Underwriting Required
PS5148AR (01/2010)		AR - Policy Change Form Underwriting Required
PS5148AZ (01/2010)		AZ - Policy Change Form Underwriting Required
PS5148CA (01/2010)		CA - Policy Change Form Underwriting Required
PS5148CO (01/2010)		CO - Policy Change Form Underwriting Required
PS5148CT (01/2010)		CT - Policy Change Form Underwriting Required
PS5148DC(01/2010)		DC - Policy Change Form Underwriting Required
PS5148US (01/2010)		US - Policy Change Form Underwriting Required
PS5148FL (01/2010)		FL - Policy Change Form Underwriting Required
PS5148HI (01/2010)		HI - Policy Change Form Underwriting Required
PS5148IA (01/2010)		IA - Policy Change Form Underwriting Required
PS5148ID (01/2010)		ID - Policy Change Form Underwriting Required
PS5148IN (01/2010)		IN - Policy Change Form Underwriting Required
PS5148KY (01/2010)		KY - Policy Change Form Underwriting Required
PS5148LA (01/2010)		LA - Policy Change Form Underwriting Required
PS5148MA (01/2010)		MA - Policy Change Form Underwriting Required
PS5148MD (01/2010)		MD - Policy Change Form Underwriting Required
PS5148ME (01/2010)		ME - Policy Change Form Underwriting Required
PS5148MI (01/2010)		MI - Policy Change Form Underwriting Required
PS5148MN (01/2010)		MN - Policy Change Form Underwriting Required
PS5148MO (01/2010)		US - Policy Change Form Underwriting Required
PS5148MT (01/2010)		MT - Policy Change Form Underwriting Required
PS5148NC (01/2010)		NC - Policy Change Form Underwriting Required
PS5148NE (01/2010)		NE - Policy Change Form Underwriting Required
PS5148NH (01/2010)		NH - Policy Change Form Underwriting Required
PS5148NJ (01/2010)		NJ - Policy Change Form Underwriting Required
PS5148NM (01/2010)		NM - Policy Change Form Underwriting Required
PS5148NV (01/2010)		NV - Policy Change Form Underwriting Required
PS5148OH (01/2010)		OH - Policy Change Form Underwriting Required
PS5148OK (01/2010)		OK - Policy Change Form Underwriting Required
PS5148OR (01/2010)		OR - Policy Change Form Underwriting Required
PS5148PA (01/2010)		PA - Policy Change Form Underwriting Required
PS5148PR (01/2010)		PR - Policy Change Form Underwriting Required
PS5148RI (01/2010)		RI - Policy Change Form Underwriting Required
PS5148TN (01/2010)		TN - Policy Change Form Underwriting Required
PS5148TX (01/2010)		TX - Policy Change Form Underwriting Required
PS5148UT (01/2010)		UT - Policy Change Form Underwriting Required
PS5148VA (01/2010)		VA - Policy Change Form Underwriting Required
PS5148VI (01/2010)		VI - Policy Change Form Underwriting Required
PS5148VT (01/2010)		VT - Policy Change Form Underwriting Required
PS5148WA (01/2010)		WA - Policy Change Form Underwriting Required
PS5148WI (01/2010)		WI - Policy Change Form Underwriting Required
PS5148WV (01/2010)		WV - Policy Change Form Underwriting Required
PS0011US (01/2010)		US - Request to Use Policy Values to Pay Premiums
PS5127US (01/2010)		US - Statement of Lost Policy


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