Pacific Educators Forms

Remittance Form- For District Use Only

You must have Microsoft Excel or an Excel-compatible viewer to open this file.

Lost Policy / Name Change / Address Change

Use this form to request special service on your account.

Policy Change Form

Use this form to make general changes. Name Change, Address Change, Decrease or Cancel Coverage.

Electronic Payment Form

Use this form to have payments deducted directly from your checking account. No need to write checks or receive paper billings.