Customer service forms
If you cannot find the form you are looking for, please feel free to contact our Customer Service Team on (01) 704 1010 or email firstname.lastname@example.org
GeneralEvidence of Health form (pdf 27kb)
To reinstate a lapsed plan, you must complete the above form and return to us. Final decision on whether we are in a position to reinstate your plan will rest with our Underwriters.Direct debit mandate (pdf 16kb)
If you would like to change the bank account details or start making payments by direct debit, please fill in the above form and return to us.
Please print and post your signed and completed form to:
Customer Services Team
Irish Life Assurance plc
Lower Abbey St.
P.O. Box 129