Agent Of Record Change

You can change the agent of record on a policy using several formats and send it electronically, by fax or by mail to your local Symetra field office. For Agent of Record changes on Select Benefits, send the request to Select Benefits Administrators.

  • All agent change requests require a policy holder signature unless an agency or principal is transferring the agent of record within their organization.
  • Upon receipt, we’ll review the application for proper signatures, agent appointment and sales agreement status. If there are any issues with the request, it will be returned along with an explanation of what’s required for approval.


Agent change requests that don’t require a customer signature can be sent electronically. Just download the form below and email it to

If a client signature is required, fax or mail the form to us:


Mailing Address:
Symetra Life Insurance Company
PO Box 3882
Seattle, WA 98124-3882

Download Agent Change form.