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Premium Billing Mode Election Form

Select or change the frequency and/or method in which you wish to pay your premiums with the Premium Billing Mode Election Form.

Available payment modes include: annual semiannual (a payment every six months), quarterly (a payment every three months), and monthly (12 payments a year).  Monthly payments can be made either by electronic fund transfer (EFT) from your bank account or by direct bill.  (Note: The minimum payment amounts required for each payment mode are listed on the form.)

Do you need more information on modal payments?

Please contact your Aurora Agent, or our office at 1-800-265-2652 for more information about modal payments and associated administrative charges.

How can I access the Premium Billing Mode Election Form?

Download the form by clicking here: Aurora Premium Billing

All Aurora forms are in Adobe Acrobat format. You will need the Adobe Acrobat Reader version 3.0 or higher in order to print these forms. If you do not have the Adobe Acrobat Reader installed on your computer, you may download it from Adobe  free of cost. You will also preferably need a laser printer to print them, although most ink jet printers will work.  Sorry - these forms will not print out correctly on dot matrix printers and some ink jet printers. 

How can I use the Premium Billing Mode Election Form?

To use this form, please download the above file and print it using the Adobe Acrobat Reader. To avoid any processing delays, please carefully fill in all required information and provide all required signatures. (Note: For your convenience, a change of address for all policy correspondence may also be made on the second page of this form.)

Mail all pages of the completed form promptly to us at:

Aurora National Life Assurance Company
P O Box 4490
Hartford, CT  06147-4490

If you are unable to download or print this form, call us at  1-800-265-2652,  and we will be happy to mail the form to you.



If you prefer to contact us by phone please call: 1-800-265-2652

Call us toll-free.

Hours of operation:
8:30 a.m. to 5:00 p.m. Eastern Time
Monday through Friday