Click on the above options to print an online version of
our policyholder form. Simply complete, sign and mail the form(s) to us at:
Combined Life Insurance Company of New York
11 British American Blvd.
Latham, NY. 12110-1405
If you have questions and would like assistance completing these forms,
our Customer Service representatives are available weekdays, 8:30 a.m.
to 6:00 p.m. Call us. We're here to help. *1-800-951-6206.
For Worksite customers, call 1-888-441-7936 (payroll deduction)
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