Forms

Benefits & Pay Forms

• Authorization Agreement for Direct Deposit (PDF 58KB)
• Change Beneficiary--Life Insurance (PDF 47KB)
• Cancellation of Group Medical Coverage for US Retirees/Surviving Spouse/Disabled and/or Dependents

Tax Forms

• W-4P (PDF 255KB)
• State Tax Withholding (PDF 168KB)

Grant Forms

• Good Neighbor Grant form
• Good Neighbor Grant print & mail form
• Matching Gift form
• Matching Gift print & mail form

Retiree Address Change Form

• Retirees Address Change Form

Retirement Plan Contingent Beneficiary Form

If you are already retired from State Farm this form is not applicable.

• Retirement Plan Contingent Beneficiary Form

Forms Address

If an address is not provided, please send the form to:

Human Resources Services Center (HRSC)
Three State Farm Plaza
Bloomington, Illinois 61791-0001