ROK LIFE Beneficiary Form

Please complete the form below to designate your chosen beneficiary for your Accidental Death Insurance and your Burial and Cremation Insurance. 


Blanket Accidental Death coverage is underwritten by Life Insurance Company of North America, 1601 Chestnut Street, Philadelphia, Pennsylvania 19192. This information is not a contract. Terms and conditions are set forth in blanket policy #AK 400010, issued to ROK Mobile, Inc. in the state of Nevada on policy form BA-01-1000.00. Coverage may not be available in all areas. The policy is subject to the laws and jurisdictions in which it is issued. All Cigna products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including Life Insurance Company of North America. “Cigna” is a registered service mark of Cigna Intellectual Property, Inc.

For Details of the Coverage, Exclusions and Limitations, View & Download the Summary of Coverage HERE.

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*These programs are NOT insurance and do not provide reimbursement for financial losses.