By completing and We are taking the utmost care for the health and safety of our employees and their families. Get this form now! How do I change my beneficiary information? Insurance fraud can be broadly defined as an intentional act or omission undertaken to gain unjustified or unlawful benefits and advantages. Note: Additional documents may be required if you are a minor beneficiary, trust beneficiary, estate beneficiary, foreign beneficiary, or a qualified retirement plan beneficiary. Get access to thousands of forms. The beneficiary will receive a claim form packet from Allianz. If you are covered by our International Healthcare Plans for the UAE, use this form to claim back eligible medical expenses. Making an investment and contending with different fund structures can be confusing. A 1035 exchange is reportable, but not taxable. If you forgot your username, please complete our Forgot username formand we will email your username to the email address associated with your account. Fixed annuities and Life insurance. Agent Eligibility Quick Guide - AEQG04. You can also download it, export it or print it out. June 29, 2022. Fixed annuities 763.582.6002 Minneapolis, MN 55416-1297, You can update your address, email, and mobile phone number online. Enter your official contact and identification details. Surrender Value: The Policy can be surrendered provided three full years premiums have been paid. Enter your official contact and identification details. Why is there a taxable amount on a loan from a nonqualified annuity? For Bajaj Allianz life insurance login to our portal policybachat.com. Feb 28, 2022. Contact us for assistance. Form 5498 is also used to report the year-end Fair Market Value information for your annuity. Please follow the instructions on the form if you would like your policy premiums deducted automatically. The IRS requires the use of specific distribution codes for different types of distributions which need to be reported separately. , 10476 378 5 Tel . like to grant access to your policy information to someone else, please print, complete, and mail the attached form to our Minneapolis, MN 55459-0060, Allianz Life Insurance Company of North America Please note that online statements are not available for some clients. The mailing address and fax number are provided on the form for your convenience. Get your online template and fill it in using progressive features. Just Now allianz continued monthly residence form. 4. For example, they might use cdc.com or cdc.org instead of cdc.gov.. Allianz Life Insurance Company of North America (Allianz), its affiliated companies, and their representatives and employees do not provide legal or tax advice. This form is provided for your convenience in the event your home health care provider does not have their own daily We follow a variety of procedures to verify that any annuity contract or life insurance policy you buy from us meets your stated needs. Log inand then go to "Archived Statements. If you are covered by our International Healthcare Plans for Mexico, use this form to claim back eligible medical expenses. If you received distributions from multiple contracts, you will get a 1099-R for each contract. For tax-qualified annuities, your first annuity payment must be issued by December 31 in the year after the death in order to avoid potential tax penalties. See Also: Continued monthly residence form cmrVerify It Show details, 5 hours ago How to fill out the Form allianz on the internet: To get started on the form, use the Fill & Sign Online button or tick the preview image of the blank. Fax: 866-722-1180. We will contact the beneficiary if additional information is needed. Are there time limitations for filing a death claim? DocHub v5.1.1 Released! If youre not sure when premium is due or how much you need to pay, contact us or confirm with your financial professional. If you own an Allianz policy or contract, you can register for online access. A 1099-R is used to report transactions that occur between January 1 and December 31 of the previous tax year from financial products such as life insurance or annuities. Long-term disability LTD benefits replace 66 23 of your base monthly. Personal contributions are reported on the form for the year for which the contributions were made. Agent Report - NB5029-EN-5. If you defaulted on loan payments from a 403(b) contract, the remaining loan balance is reported as taxable; however, the loan is still outstanding. To review your RMD payment schedule, register or log in to the Allianz Life website (www.allianzlife.com). Use this step-by-step guide to fill out the Form allianz swiftly and with ideal accuracy. Success. 6 hours ago Step 3: Processing. Cna continued monthly residence form Sunflower. Surrender value is the amount of premium refunded to the policyholder after a few years of premium payment. The 2022 IRS Form 5498 will reflect this change and will not show an RMD is required in 2023 for individuals whoare impacted. Share your form with others Send allianz form s2043 via email, link, or fax. Transfer Ownership and/or Change Beneficiaries. For those born in 1951, their first RMD will not be due until they turn age 73. After you contact us, the designated primary beneficiary will be mailed our claim form packet. The display of third-party trademarks and trade names on this site does not necessarily indicate any affiliation or endorsement of daily-catalog.com. I own a trust can I create an account online? Pay form to SHIP. The information on the form will be furnished to the IRS by the required due date. Fax 763.582.6004 Open them in the editor, fill out, e-sign, and share them right from your browser. Claim Professional largelawfarmprofliability Form. A confirmation letter will also be mailed under separate cover that includes payment and taxability details. The guaranteed minimum surrender value in case of surrender before the due date of first survival benefit is 30 % of all premiums paid excluding the first year premium and the premiums for all additional benefits. How to create an eSignature for the allianz care form. Many prospective customers may find it hard to trust an annuity firm, but the industry has put in place guidelines to evaluate these companies. ", Address changes can be made online. Thats why weve designed our claims process in three steps so you can focus on what matters most. PO Box 59060 This checklist does not, If you choose to assign your long-term care insurance benefits to your covered provider, this form is required from your, Authorization to Release Medical Information, W-9 Request for Taxpayer Identification Number and Certification. Edit your allianz life beneficiary change form online. We will contact the beneficiary if additional information is needed. By using this site you agree to our use of cookies as described in our, Something went wrong! Email: longtermcareclaims@metlife.com The beneficiary will receive a claim form packet from Allianz. CLAIM FORM202 KB Also available in the following languages: ARABIC CLAIM FORM241 KB CHINESE CLAIM FORM619 KB LATVIAN CLAIM FORM238 KB RUSSIAN CLAIM FORM306 KB Regional Healthcare Plans Upon receipt of the completed claim form packet and proof of death (i.e., death certificate) from the beneficiary, we will evaluate the claim within 10 business days or within applicable state requirements. Upon receipt of the completed claim form packet and proof of death (i.e., death certificate) from the beneficiary, we will evaluate the claim within 10 business days or within applicable state requirements. Our highest priority is the health and well-being of our customers, partners, and employees during these extraordinary times. The surrender value of Bajaj Allianz Life insurance policy is calculated as a Single premium multiplied by 75% of the outstanding term to maturity/ total term. We encourage you to talk with a financial professional about the role an annuity can play in your overall financial plan. 360 Qualified Plan Acknowledgement Form and ERISA Disclosure - 360-ERPOS. Complete the blank fields; involved parties names, places of residence and phone numbers etc. Get the Senior Health Insurance Company Pennsylvania Continued Monthly Residence Form you want. Representative must be appointed with Allianz Life Insurance Company of North America. Alternatively, you can submit the form via email, mail, or fax. If you will receive the first payment outside of these timeframes, contact us to discuss your specific situation. Choose My Signature. What is insurance fraud and how do I protect myself? ", You can make beneficiary changes online. If you perform an eligible 60-day rollover (indirect rollover), the IRS Form 5498 from the receiving company should report the receipt of the indirect rollover contribution. The Direction to Pay form is provided as a convenience to our policyholders and their care providers List of currently available ALLIANZ LIFE forms on Laser App, 222 Qualified Plan Acknowledgement Form and ERISA Disclosure - 222-ERPOS, 360 Qualified Plan Acknowledgement Form and ERISA Disclosure - 360-ERPOS, ABC Lifetime Withdrawal Election Form - S2301, ABC Qualified Plan Acknowledgement Form and ERISA Disclosure - ABC-ERPOS, Allianz 222 Annuity Disclosure - 222-DISC-NJ [NJ], Allianz 360 Annuity Disclosure - 360-DISC-NJ [NJ], Allianz ABC Annuity Disclosure - ABC-DISC-NJ [NJ], Allianz Core Income 7 Annuity Disclosure - CI7-DISC-NJ [NJ], Allianz Endurance Plus Annuity Disclosure - DISC50915-NJ03 [NJ], Allianz Index Advantage ADV Disclosure - IXA-DISC-ADV [PA], Allianz Index Advantage ADV Disclosure - IXA-DISC-MN-ADV [MN], Allianz Index Advantage Disclosure - INY-DISC [NY], Allianz Index Advantage Disclosure - IXA-DISC-MN [MN], Allianz Index Advantage Disclosure - IXA-DISC-PA [PA], Allianz Index Advantage Income Disclosure - IAI-DISC, Allianz Index Advantage Income Disclosure - IAI-DISC-MN [MN], Allianz Index Advantage Income Disclosure - IAI-DISC-PA [PA], Allianz Index Advantage NF Disclosure - IXA-DISC-MN-NF [MN], Allianz Index Advantage NF Disclosure - IXA-DISC-NF [MA-PA-VA], Allianz MasterDex X Annuity Disclosure - DISC52575-NJ01 [NJ], Allianz PRIME Plus Benefit Election Form for Reset of Annual Increase - USA-1282 [Generic], Allianz PRIME Plus Benefit Selection - USA-1279 [Generic], Allianz Request for Tax Withholding Change - SFAL0010, Allianz Request for Tax Withholding Change - SFAL0010-NY [NY], Allianz Retirement Advantage Lifetime Income Payment Selection Form - REA-014 [Generic], Allianz Retirement Advantage Lifetime Income Payment Selection Form - REA-014-NJ [NJ], Allianz Retirement Advantage NY Lifetime Income Payment Selection Form - REA-014-NY [NY], Allianz Retirement Advantage NY Variable Annuity Dollar Cost Averaging Instruction - REA-012-NY [NY], Allianz Retirement Advantage Variable Annuity Dollar Cost Averaging (DCA) Instructions - REA-012, Allianz Retirement Advantage Variable Annuity Flexible Rebalancing Instructions - REA-013, Allianz Retirement Advantage Variable Annuity Flexible Rebalancing Instructions - REA-013-NY [NY], Allianz Retirement Foundation ADV Annuity Application - ICC17-RFA-APP [Generic], Allianz Retirement Foundation ADV Annuity Application - RFA-APP [DC-DE-ND-SD], Allianz Retirement Foundation ADV Annuity Application - RFA-APP-CA [CA], Allianz Retirement Foundation ADV Annuity Application - RFA-APP-CT [CT], Allianz Retirement Foundation ADV Annuity Application - RFA-APP-FL [FL], Allianz Retirement Foundation ADV Annuity Application - RFA-APP-LA [LA], Allianz Retirement Foundation ADV Annuity Application - RFA-APP-NF, Allianz Retirement Pro - Income Advantage Payment Selection/Change Form - PLI-105-NY [NY], Allianz Retirement Pro NY Variable Annuity Withdrawal Request - PLI-110-NY [NY], Allianz RFA Annuity Disclosure - RFA-DISC-01-NJ [NJ], Allianz Vision - Add Income Protector to Existing Contract - USA-1453 [Generic], Allianz Vision - Income Focus Payment Selection/Change Form - PLI-123-NY [NY], Allianz Vision - Remove Form - USA-1419 [Generic], Allianz Vision - Remove Form - VNY-047 [NY], Allianz Vision and Allianz Collections - Income Focus Payment Selection/Change - USA-1729-NJ [NJ], Allianz Vision and Allianz Collections - Income Focus Payment Selection/Change Form - USA-1729, Allocation Change Form - Allianz Valuemark II - PLI-302-NY [NY], Allocation Change Form - Allianz Valuemark II - USA-1700 [Generic], Allocation Change Form - Alterity/ Rewards - USA-1649, Allocation Change Form - Custom Income - USA-1328 [Generic], Allocation Change Form - High Five NY/Advantage/Opportunity and Charter II NY - PLI-088 [NY], Allocation Change Form - High Five/High Five L/High Five Bonus - USA-1329 [Generic], Allocation Change Form - Retirement Pro - PLI-102-NY [NY], Allocation Change Form - Vision and Connections - Income Focus - USA-1728, Allocation Change Form - Vision and Connections - Income Protector (old) - USA-1451 [Generic], Allocation Change Form - Vision and Connections - Income Protector - USA-1727, Allocation Change Form - Vision and Connections - Investment Protector (old) - USA-1452 [Generic], Allocation Change Form - Vision and Connections - Investment Protector - USA-1780, Allocation Change Form - Vision and Connections - LPB and TDR - USA-1330 [Generic], Allocation Change Form - Vision and Connections - No Additional Benefit - USA-1781, Allocation Change Form - Vision NY - Income Focus - PLI-122-NY [NY], Allocation Change Form - Vision NY - Income Protector (old) - VNY-052 [NY], Allocation Change Form - Vision NY - Income Protector - VNY-162 [NY], Allocation Change Form - Vision NY - Investment Protector (old) - VNY-053 [NY], Allocation Change Form - Vision NY - Investment Protector - VNY-177 [NY], Allocation Change Form - Vision NY - LPB and TDR - PLI-089-NY [NY], Allocation Change Form - Vision NY - No Additional Benefit - VNY-178 [NY], Allocation Change Request Form - S2213-10, Allocation Change Request Form - S2213-12, Allocation Change Request Form - S2213-13, Allocation Change Request Form - S2213-14, Allocation Change Request Form - S2213-15, Allocation Change Request Form - S2213-16, Allocation Change Request Form - S2213-17, Allocation Change Request Form - S2213-18, Allocation Change Request Form - S2213-19, Allocation Change Request Form - S2213-20, Allocation Change Request Form - S2213-SR-20, Allocation Change Request Form - S2213-SR-9, Allocation Change Request Form - S2305 [IA], Allocation Change Request Form - S2306 [NH], Annuitant Change Request - SFAL0018-LA [LA], Annuitization Quote Request - PLI-119-NY [NY], Annuitizing Annuity and Life Contracts - PLI-115-NY [NY], Annuitizing Annuity and Life Contracts Packet - PLI-107-NY [NY], Annuitizing Annuity and Life Contracts Packet - USA-487 [Generic], Annuitizing Annuity Contracts and Life Insurance Policies - SFAL-0004, Annuitizing Annuity Contracts and Life Insurance Policies - SFAL-0004-NY [NY], Annuity Application - Bonus MasterDex - AP-50626-NY [NY], Annuity Application - ICC18-FIA-APP-ALT [IA], Annuity Application - ICC18-FIA-APP-MT [MT], Annuity Application - MasterDex - AP-50614-NY [NY], Authorization to Release Information - S2194, Authorization to Transfer Assets from a Financial Institution (Fixed) - S2255, Authorization to Transfer Assets from a Financial Institution (Fixed) - S2255-NY [NY], Authorization to Transfer Assets from a Financial Institution (Variable) - S2255, Authorization to Transfer Assets from a Financial Institution (Variable) - S2255-NY [NY], Automatic Investment Plan (AIP) Form - PLI-032-NY [NY], Automatic Investment Plan (AIP) Form - USA-1278 [Generic], Automatic Payment Plan - EFT Authrorization - NBAL0042, Automatic Payment Plan - EFT Authrorization - NBAL0042-NY [NY], Beneficial/Inherited IRA RMD Election Form - NBAL0036, Beneficial/Inherited IRA RMD Election Form - NBAL0036-NY, Beneficiary Designation Request - SFAL0012, Beneficiary Designation Request - SFAL0012-NY [NY], Beneficiary Stretch Distribution - PLI-098-NY [NY], Beneficiary Stretch Distribution - USA-1265N [Generic], Benefit Deposited with Interest Option Claim Form - S2070-01, Buyer's Guide for Fixed Deferred Annuities - ANB-LE (1999), Buyer's Guide for Fixed Deferred Annuities - ANB-LE (2013) [Generic], Buyers Guide for Deferred Annuities (Variable) - ANB-LA [GA], Buyers Guide for Deferred Annuities - ANB-LV (2013) [AL-CO-FL-GA-IA-ME-MO-NH-OH-RI-TX-WV-WI], Buyers Guide to Fixed Indexed Annuities - NB4023 [VT], California Elder Disclosure - NBAL0053 [CA], California Senior (age 60 or older) Free Look - USA-699 [CA], Certification for 72(t) and 72(q) Withdrawals - USA-388N, Certification for 72(t) and 72(q) Withdrawals - USA-388NY [NY], Certification of Attorney-in-Fact Form - NBAL0052, Certification of Attorney-in-Fact Form - NBAL0052-NY [NY], CI7 Qualified Plan Acknowledgement Form and ERISA Disclosure - CI7-ERPOS, Civil Union and Equality Act of 2011 Notice - NB6079 [DE], Client Contract Update Request - USA-383 [Generic], Client Contract Update Request - USA-383NY [NY], Command Provider Annuity Application - AIMS-CP [Generic], Command Provider Annuity Application - AIMS-CP-FL [FL], Command Provider Annuity Application - AIMS-CP-MA [MA], Command Provider Annuity Application - AIMS-CP-OR [OR], Command Provider Annuity Application - AIMS-CP-TX [TX], Commission Information Quick Guide - CIQG04, Connections Qualified Acknowledgement Form and ERISA Disclosure - CNT-ERPOS, Continuing Annuity Option Settlement Claim Form - S2069-01, Continuing Annuity Option Settlement Claim Form - S2069-NY [NY], Custom Income Flexible Rebalancing - USA-059 [Generic], Custom Income Variable Annuity Income Option Selection - CST-015 [Generic], Customer Authorization of Transfer by Third Party - USA-1300 [Generic], Customer Authorization of Transfer by Third Party - USA-1300-NY [NY], Customer Authorization of Transfer by Third Party Money Manager - USA-1301 [Generic], Customer Authorization of Transfer by Third Party Money Manager - USA-1301-NY [NY], Disclosure Form/Preliminary Contract Summary - 222-SOU-AZ [AZ], Disclosure Form/Preliminary Contract Summary - ABC-SOU-AZ [AZ], Disclosure Form/Preliminary Contract Summary - Allianz 360 - 360-SOU-AZ [AZ], Disclosure Form/Preliminary Contract Summary - Allianz Core Income 7 - CI7-SOU-AZ [AZ], Disclosure to California Residents (age 65 or older) - USA-090 [CA], Disclosure to Minnesota Resdients - Index Advantage ADV - IXA-DISC-MN2-ADV [MN], Disclosure to Minnesota Residents - Index Advantage ADV - IXA-DISC-MN2-NF [MN], Disclosure to Minnesota Residents - Index Advantage Income - IAI-DISC-MN2, Dollar Cost Averaging (DCA) - PLI-030NY [NY], Dollar Cost Averaging (DCA) - Retirement Pro - PLI-103-NY [NY], Dollar Cost Averaging (DCA) - USA-354 [Generic], Dollar Cost Averaging - Alterity/ Rewards - USA-1650, Enhanced Withdrawal Benefit (EWB) Election Form - S2291, Entity Customer Information Form - NBAL0055 [Generic], Entity Customer Information Form - NBAL0055-NY [NY], ERISA Section 408(b)(2) Disclosure - DISC52575-ERPOS, ERISA Section 408(b)(2) Disclosure - DISC54370-ERPOS, ERISA Section 408(b)(2) Disclosure - DISC59951-02-ERPOS, ERISA Section 408(b)(2) Disclosure - DISC95374-ERPOS, ERISA Section 408(B)(2)Disclosure - DISC95376-ERPOS, Five Year Deferral Service Form - S2241 [Generic], Five Year Deferral Service Form - S2241-NY [NY], Flexible Rebalancing - Alterity/ Rewards - USA-1651, Flexible Rebalancing - Retirement Pro - PLI-104-NY [NY], Income Maximizer Rider Disclosure Form - SOU95331-03-AZ [AZ], Income Maximizer Rider Statement of Understanding - SOU95331-03 [Generic], Income Maximizer Rider Statement of Understanding - SOU95331-03-CT [CT], Income Maximizer Rider Statement of Understanding - SOU95331-03-FL [FL], Income Maximizer Rider Statement of Understanding - SOU95331-03-OK01 [OK], Income Maximizer Rider Statement of Understanding - SOU95331-03-WI [WI], Income Maximizer Rider Statement of Understanding - SOU95331-GMV-03 [DE-IL-OH-TX], Income Maximizer Rider Statement of Understanding - SOU95331-GMV-03-NC [NC], Income Maximizer Rider Statement of Understanding - SOU95331-GMV-03-NJ [NJ], Income Maximizer Rider Statement of Understanding - SOU95331-ICC-04 [MN-MO-MS-UT], Income Maximizer Rider Statement of Understanding - SOU95331-ICC-04-OR [OR], Income Maximizer Rider Statement of Understanding - SOU95331-ICC-04-PA [PA], Income Maximizer Rider Statement of Understanding - SOU95331-ICC-NFWR-04 [AK-WA], Income Maximizer Rider Statement of Understanding - SOU95331-MSRP-03-CA [CA], Income Maximizer Rider Statement of Understanding - SOU95331-NFWR-03 [MA-SD], Income Payment Selection/Change Form - IAI-153 [Generic], Income Plus / Simple Income Benefit Election Form for Contract - S2212-1, InCommandDex Annuity Request for Annuity Settlement Options - S2160, Index Advantage ADV Qualified Plan Acknowledgement Form and ERISA Disclosure - IXA-ERPOS-ADV, Index Advantage ADV Variable Annuity Application Tipsheet - IXA-001-ADV, Index Advantage Income Qualified Acknowledgement Form and ERISA Disclosure - IAI-ERPOS, Index Advantage Income Variable Annuity Application - IAI-APP-03 [CA-DE-ND-SD], Index Advantage Income Variable Annuity Application - IAI-APP-03-FL [FL], Index Advantage Income Variable Annuity Application - IAI-APP-03-LA [LA], Index Advantage Income Variable Annuity Application - IAI-APP-03-NC [NC], Index Advantage Income Variable Annuity Application - ICC20-IAI-APP-03 [Generic], Index Advantage Income Variable Annuity Application - ICC20-IAI-APP-03-NJ [NJ], Index Advantage Income Variable Annuity Application - ICC21-IAI-APP-03-MN [MN], Index Advantage Income Variable Annuity Application Tipsheet - IAI-001, Index Advantage New York Qualified Plan Acknowledgement Form and ERISA Disclosure - INY-ERPOS [NY], Index Advantage New York Regulation 60 Forms Package - INY-055 [NY], Index Advantage NF Qualified Plan Acknowledgement Form and ERISA Disclosure - IXA-ERPOS-NF, Index Advantage NF Variable Annuity Application Tipsheet - IXA-001-NF, Index Advantage Qualified Plan Acknowledgement Form and ERISA Disclosure - IXA-ERPOS, Index Advantage Variable ADV Annuity Application - ICC20-IXA-APP-03-ADV [Generic], Index Advantage Variable ADV Annuity Application - ICC20-IXA-APP-03-NJ-ADV [NJ], Index Advantage Variable ADV Annuity Application - ICC21-IXA-APP-03-MN-ADV [MN], Index Advantage Variable ADV Annuity Application - IXA-APP-03-ADV [CA-DE-ND-SD], Index Advantage Variable ADV Annuity Application - IXA-APP-03-FL-ADV [FL], Index Advantage Variable ADV Annuity Application - IXA-APP-03-LA-ADV [LA], Index Advantage Variable ADV Annuity Application - IXA-APP-03-NC-ADV [NC], Index Advantage Variable ADV Annuity Application - IXA-APP-MOWA-01-ADV [MO-WA], Index Advantage Variable ADV Annuity Application - IXA-APP-MT-ADV [MT], Index Advantage Variable Annuity Application - F40538-02-NY [NY], Index Advantage Variable Annuity Application - ICC20-IXA-APP-03 [Generic], Index Advantage Variable Annuity Application - ICC20-IXA-APP-03 [HI], Index Advantage Variable Annuity Application - ICC20-IXA-APP-03-NJ [NJ], Index Advantage Variable Annuity Application - ICC21-IXA-APP-03-MN [MN], Index Advantage Variable Annuity Application - IXA-APP-03 [CA-DE-ND-SD], Index Advantage Variable Annuity Application - IXA-APP-03-FL [FL], Index Advantage Variable Annuity Application - IXA-APP-03-LA [LA], Index Advantage Variable Annuity Application - IXA-APP-03-NC [NC], Index Advantage Variable Annuity Application - IXA-APP-MOWA-01 [MO-WA], Index Advantage Variable Annuity Application Tipsheet - INY-016 [NY], Index Advantage Variable Annuity Application Tipsheet - IXA-001, Index Advantage Variable NF Annuity Application - ICC17-IXA-APP-NF [MT], Index Advantage Variable NF Annuity Application - ICC20-IXA-APP-03-NF [Generic], Index Advantage Variable NF Annuity Application - ICC20-IXA-APP-03-NJ-NF [NJ], Index Advantage Variable NF Annuity Application - ICC21-IXA-APP-03-MN-NF [MN], Index Advantage Variable NF Annuity Application - IXA-APP-03-FL-NF [FL], Index Advantage Variable NF Annuity Application - IXA-APP-03-LA-NF [LA], Index Advantage Variable NF Annuity Application - IXA-APP-03-NC-NF [NC], Index Advantage Variable NF Annuity Application - IXA-APP-03-NF [CA-DE-ND-SD], Index Advantage Variable NF Annuity Application - IXA-APP-MOWA-01-NF [MO-WA], Index Anniversary Rebalance Form - IAI-022 [Generic], Index Anniversary Rebalancing and Transfers between the Allocation Options - INY-019 [NY], Index Anniversary Rebalancing and Transfers between the Allocation Options - IXA-022, Individual Customer Information Form - NBAL0054 [Generic], Individual Customer Information Form - NBAL0054-NY [NY], Interested Party Statement Request - USA-851 [Generic], Interested Party Statement Request - USA-851-NY [NY], Investment Advisor Representative Client Authorization - NBAL0043, Investment Advisor Representative Client Authorization - NBAL0043-NY [NY], Investment Advisor Representative Information - NBAL0044, Investment Advisor Representative Information - NBAL0044-NY [NY], Investment Allocation Guide - VNY-142 [NY], Investment Allocation Guide - VSN-145 [Generic], IRA Excess Contribution Removal Form - S2235, IRA Excess Contribution Removal Form - USA-1506 [Generic], IRA Excess Contribution Removal Form - USA-1506-NY [NY], Lifetime Withdrawal Benefit/Income Maximizer Election Form - S2212-PREFD, Military Sales Forms Packet - USA-1461 [Generic], Military Sales Forms Packet - USA-1461 [NY], Non-Individual Ownership Form - NB6059-NY [NY], Non-Individual Ownership Form - PLI-086 [NY], Non-Individual Ownership Form - USA-1327 [Generic], Nonresident Sales Form - Information Page - NBAL6078, Nonresident Sales Form - Information Page - NBAL6078-NY [NY], Notice Regarding Medi-Cal Eligibility (Fixed) - NB5003-CA [CA], Notice Regarding Medi-Cal Eligibility (Variable) - NB5003-CA [CA], Notice to Connecticut Financial Professionals - IXA-DISC-CT2 [CT], Partial Settlement Options Request for Contract - S2247, Partial Settlement Options Request for Contract - S2247-NY [NY], Performance Lock Request Form - INY-106 [NY], Policy Payment Electronic Funds Transfer (EFT) - Clients - S2071, Policy Payment Electronic Funds Transfer (EFT) - Clients - S2071-NY [NY], PRIME - Guaranteed Partial Withdrawal Benefit (GPWB) Payment Election - 403(b) - PLI-100-NY [NY, PRIME - Guaranteed Partial Withdrawal Benefit (GPWB) Payment Election - 403(b) - USA-1567 [Generic], PRIME - Guaranteed Partial Withdrawal Benefit (GPWB) Payment Election - USA-1519 [Generic], PRIME Plus (GPWB) Payment Election - USA-1520, Producer Change Request - S2249 [Generic], Product Suitability Form - NB3051 [Generic], Product Suitability Form - NB3051-CA [CA], Product Suitability Form - NB3051-FL-02 [FL], Product Suitability Form - NB3051-MA [MA], Product Suitability Form - NB3051-MT [MT], Product Suitability Form - NB3051-NJ [NJ], Qualified Disbursement Request - S2085-NY [NY], Qualified Plan Acknowledgement - USA-337-NY [NY], Qualified Plan Acknowledgement and Custodial IRA Agreement - S2236, Qualified Plan Acknowledgement and Custodial IRA Agreement - S2236-NY [NY], Quick Tips for Completing the NY Reg 60 Disclosure Statement - PLI-120-NY [NY], Reg 60 Part D Tipsheet - Index Advantage NY - PLI-125-NY-IXA [NY], Reg 60 Part D Tipsheet - Retirement Pro NY - PLI-125-NY-RET [NY], Registered Representative Appointment Request - USA-678A [Generic], Registered Representative Appointment Request - USA-678NY [NY], Regulation 60 Disclosure Statement - NB2273-NY [NY], Regulation 60 Sales Material Checklist - NB2274-NY [NY], Regulation 60 Sales Material Checklist - PLI-081-NY [NY], Regulation 60 Six-Step Process - NB2278-NY [NY], Regulation 60 VA Disclosure Statement - PLI-092-NY [NY], Regulation 60 VA Replacement - PLI-090-NY [NY], Replacement Comparison Worksheet (Fixed) - NBAL0023-AR [AR], Replacement Comparison Worksheet (Variable) - NBAL0023-AR [AR], Replacement Comparison Worksheet - NB6023, Replacement Comparison Worksheet Tip Sheet (Fixed) - NBAL0022-AR [AR], Replacement Comparison Worksheet Tip Sheet (Variable) - NBAL0022-AR [AR], Replacement List (Fixed) - NBAL0028-IL [IL], Replacement Notice (Fixed) - NBAL0026-IL [IL], Replacement Notice (Fixed) - NBAL0037-KS [KS], Replacement Notice (Fixed) - NBAL0038-KS [KS], Replacement Of Life Insurance Or Annuities (Fixed) - NBAL0021-MO [MO], Replacement Of Life Insurance Or Annuities (Variable) - NBAL0021-MO [MO], Replacement Packet (Fixed) - NBAL0001-01 [LA-VA], Replacement Packet (Fixed) - NBAL0001-MO [MO], Replacement Packet (Fixed) - NBAL0002-CA [CA], Replacement Packet (Fixed) - NBAL0003-DE [DE], Replacement Packet (Fixed) - NBAL0004-FL [FL], Replacement Packet (Fixed) - NBAL0005-GA [GA], Replacement Packet (Fixed) - NBAL0006-ID [ID], Replacement Packet (Fixed) - NBAL0007-IL [IL], Replacement Packet (Fixed) - NBAL0008-IN [IN], Replacement Packet (Fixed) - NBAL0009-MA [MA], Replacement Packet (Fixed) - NBAL0010-MI [MI], Replacement Packet (Fixed) - NBAL0011-MN [MN], Replacement Packet (Fixed) - NBAL0013-ANN-NV [NV], Replacement Packet (Fixed) - NBAL0014-OK [OK], Replacement Packet (Fixed) - NBAL0015-PA [PA], Replacement Packet (Fixed) - NBAL0017-TN [TN], Replacement Packet (Fixed) - NBAL0018-WA [WA], Replacement Packet (Fixed) - NBAL0019-WY [WY], Replacement Packet (Fixed) - NBAL0020-AR [AR], Replacement Packet (Variable) - NBAL0001-01 [LA-VA], Replacement Packet (Variable) - NBAL0001-MO [MO], Replacement Packet (Variable) - NBAL0002-CA [CA], Replacement Packet (Variable) - NBAL0003-DE [DE], Replacement Packet (Variable) - NBAL0004-FL [FL], Replacement Packet (Variable) - NBAL0005-GA [GA], Replacement Packet (Variable) - NBAL0006-ID [ID], Replacement Packet (Variable) - NBAL0007-IL [IL], Replacement Packet (Variable) - NBAL0008-IN [IN], Replacement Packet (Variable) - NBAL0009-MA [MA], Replacement Packet (Variable) - NBAL0010-MI [MI], Replacement Packet (Variable) - NBAL0011-MN [MN], Replacement Packet (Variable) - NBAL0013-ANN-NV [NV], Replacement Packet (Variable) - NBAL0014-OK [OK], Replacement Packet (Variable) - NBAL0015-PA [PA], Replacement Packet (Variable) - NBAL0017-TN [TN], Replacement Packet (Variable) - NBAL0018-WA [WA], Replacement Packet (Variable) - NBAL0019-WY [WY], Replacement Packet (Variable) - NBAL0020-AR [AR], Replacement Packet - NAIC/multi-state (Fixed) - NBAL0001, Replacement Packet - NAIC/Multi-state (Variable) - NBAL0001, Representative/Agent Change Form - PLI-037NY [NY], Representative/Agent Change Form - USA-374 [Generic], Request for Allocation Change Form - S2068, Request for Allocation Change Form - S2266, Request for Allocation Change Form - S2266-1, Request for Allocation Change Form - S2266-2, Request for Allocation Change Form - S2267-1 [CA-HI-ID-OK-OR-RI], Request for Allocation Change Form - S2267-2, Request for Allocation Change Form - S2268, Request for Allocation Change Form - S2268-1, Request for Allocation Change Form - S2269, Request for Allocation Change Form - S2269-1, Request for Allocation Change Form - S2269-2, Request for Allocation Change Form - S2269-3, Request for Allocation Change Form - S2269-SR, Request for Allocation Change Form - S2269-SR-1, Request for Allocation Change Form - S2269-SR-2, Request for Allocation Percentage Chage (Optionsa) - MasterDex X - S2213-SR-5, Request for Allocation Percentage Change - BonusDe Elite, FlexDex MC Elite - S2075, Request for IRA Contribution Recharacterization - SFAL-0006, Request for IRA Contribution Recharacterization - SFAL-0006-NY, Request for IRA Recharacterization - S2187, Request for IRA Recharacterization - USA-1504 [Generic], Request for IRA Recharacterization - USA-1504-NY [NY], Request for Roth IRA Conversion - SFAL-0008 [Generic], Request for Tax Reporting of Premature Distribution Due to Disability - USA-1299 [Generic], Request for Tax Reporting of Premature Distribution Due to Disability - USA-1299-NY [NY], Request to Change Contract Information - S2004 [Generic], Request to Change Contract Information - S2004-NY [NY], Required Minimum Distribution (RMD) - Retirement Pro - PLI-112-NY [NY], Required Minimum Distribution (RMD) - USA-382N [Generic], Required Minimum Distribution (RMD) - USA-382NY [NY], Required Minimum Distribution Election Form - S2230 [Generic], Required Minimum Distribution Election Form - S2230-NY [NY], Retirement Pro - Certification for IRC Sec 72(t) or 72(q) Withdrawals - PLI-111-NY [NY], Retirement Pro VA 72(t) or 72(q) Withdrawals - USA-1598, Retirement Pro VA Allocation Change Form - USA-1574, Retirement Pro VA Dollar Cost Averaging (DCA) - USA-1575, Retirement Pro VA Flexible Rebalancing - USA-1576, Retirement Pro VA Income Advantage Payment Selection/Change Form - USA-1577, Retirement Pro VA Income Advantage Payment Selection/Change Form - USA-1577-NJ, Retirement Pro VA Required Minimum Distribution (RMD) - USA-1585, Retirement Pro VA Systematic Withdrawal - USA-1578, Retirement Pro VA Withdrawal Request - USA-1597, RFA Qualified Plan Acknowledgement Form and ERISA Disclosure - RFA-ERPOS, Rollover Notice - 403(b) - SFAL-0002-NY [NY], Rollover Notice Regarding Retirement Plan Payments - PLI-095-NY [NY], Sep IRA Excess Contribution Removal Form - USA-1507 [Generic], Sep IRA Excess Contribution Removal Form - USA-1507-NY [NY], SEP or SIMPLE Excess Contribution Removal Form - S2234, Settlement for Annuity Benefits - S2043-NY [NY], Simple Income II Rider Statement of Understanding - SOU91050-2 [DE-IA-MN-OH], Source of Payment (Fixed) - NBAL0041-NY [NY], Source of Payment (Variable) - NBAL0041-NY [NY], State Withholding Tax Guide - NBAL0035-NY [NY], Statement of Understanding - Death Benefit Rider - NB2222 [Generic], Statement of Understanding - Death Benefit Rider - NB2222-AZ [AZ], Statement of Understanding - Death Benefit Rider - NB2222-MT [MT], Statement of Understanding - Death Benefit Rider - NB2222-OK [OK], Statement of Understanding - Flexible Withdrawal Rider - SOU95178-1 [Generic], Statement of Understanding - Flexible Withdrawal Rider - SOU95178-1-PA [PA], Statement of Understanding/Preliminary Contr.
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