Service Forms
Need to change your beneficiary? File a claim? Request a withdrawal? All of the forms you may need are just a few questions away.
First, we need to find out more about your product...
What type of contract or policy do you have?
What is the name of the issuing company listed on your contract or policy?
What type of life policy do you have?
What was the original issuing company of your policy?
What was the original issuing company of your policy?
What is the name of the issuing company listed on your contract or policy?
What was the original issuing company of your policy?
Does your contract number begin with NY1 or 66?
Does your contract begin with:
What was the original issuing company name?
What is the name of the issuing company listed on your contract or policy?
What is the name of the issuing company listed on your contract or policy?
Why the questions?
Because we've grown through the acquisition of multiple companies, with separate support teams.
Can't find the form you're looking for?
Call 888-ANNUITY (888-266-8489) and we'll be happy to help you.
Your results...
Call 855-615-2276 to speak to an Alliance-One customer service representative.
Your results...
Call 877-462-8992 to speak to an Alliance-One customer service representative.
Your results...
Administrative Forms
- Address Change Request
- Name Change Request
- Electronic Funds Transfer Fund
- Authorization to Release Information
- Pension Plan Verification
Policy Change Forms
- Beneficiary Change Request
- Additional Beneficiaries Designation- Supplement to Beneficiary Change
- Trust Verification Form
- Request for Service Form
- Change of Ownership Form
- Income Benefit Rider Election and Service Request Form - TargetPay and TargetPay Plus
Withdrawal Request Forms
- Required Minimum Distribution (RMD) Request
- Systematic Withdrawal Form
- Withdrawal Request
- Withdrawal Request - Tax Sheltered Annuity (TSA)
- Qualified Charitable Distribution (QCD)
- Income Rider Withdrawal Request for BPA Income
- Income Rider Withdrawal Request for Fixed Products
- Income Rider Withdrawal Request for Indexed Products
- Income Rider Withdrawal Request for LifeTime Solutions Annuity
- Terminal Illness Withdrawal Packet
- Confinement Withdrawal Packet
Tax Forms
Buyer's Guides
Claim Forms
- Annuity Claim Form Statement of Beneficiary - for beneficiaries of contracts in a payout/settlement status
- Life Claim Form - for beneficiaries of American Investors Life policies
- Individual Beneficiary Qualified Claims Form Kit
- Entity Beneficiary Claims Form Kit
- Individual Beneficiary Non-Qualified Claims Form Kit
- Trust Beneficiary Claims Form Kit
- Estate Beneficiary Claims Form Kit
Your results...
Call 888-266-8489 to speak to a customer service representative.
Your results...
Administrative Forms
- Electronic Funds Transfer (EFT) Authorization
- Address Change Form
- Name Change Form
- Power of Attorney Affidavit
- Authorization to Release Policy Information
- Verification of Trust
Policy Change Form
- Beneficiary Change Form
- Ownership Change Form
- Collateral Assignment of Life Insurance or Non-Qualified Annuity Form
- Transfer of Collateral Assignment
- Collateral Assignment Release
- Request for Policy Change
- Request for Policy Change Flexible Premium Universal Life
- Request to Convert – Term Policy to Whole Life
- Request to Change to Extended Term or Reduced Paid Up
Withdrawal Forms
- Request for Full/Partial Surrender - Life Insurance
- Life Loan Agreement
- Request for Distribution of Life Insurance Maturity Proceeds
- Athene Annuity & Life Assurance Company of New York Appendix 10A (Alternate 1)
- Athene Annuity & Life Assurance Company of New York Appendix 10C (Alternate 1)
- Athene Annuity & Life Assurance Company of New York Appendix 11 (Alternate 1)
Your results...
Call 800-866-9933 to speak to a Protective Life Insurance customer service representative.
Your results...
Call 800-866-9933 to speak to a Protective Life Insurance customer service representative.
Your results...
Administrative Forms
- Authorize an Electronic Funds Transfer EFT
- Authorize to release policy information
- Name Change Form
- Address Change Form
- Electronic Funds Deposit Authorization
- Request a duplicate policy certificate
- Affidavit of Power of Attorney
Policy Change Forms
- Change of Annuitant Form
- Beneficiary Change Form
- Owner Change Form
- Trust Verification Form
- Assign my policy and I live in Louisiana
- Collateral Assignment Release Form
- Collateral Assignment Form
- Transfer of Collateral Assignment Form
- Change of Payee
- Co-Owner Change Form
- Pension Plan Verification Form
- Company, Partnership or LLC Verification Form
- Divorce Affidavit Form
Withdrawal Request Forms
- Annuitize my contract
- Authorize automatic withdrawals from my annuity contract
- Make a partial withdrawal from my annuity contract
- Surrender my annuity contract
- Request a required minimum distribution
- Make a partial withdrawal from my TSA/403b contract
- Surrender my TSA/403b contract
- Substantially Equal Periodic Payments under 72q & 72t
Transfer/Rollover Forms
Your results...
Call 800-866-9933 to speak to a Protective Life Insurance customer service representative.
Your results...
Administrative Forms
- Authorize to Release Policy Information
- Name Change Form
- Address Change Form
- Electronic Funds Deposit Authorization
- Affidavit of Power of Attorney
Policy Change Forms
- Change of Annuitant Form
- Beneficiary Change Form
- Owner Change Form
- Trust Verification Form
- Collateral Assignment Release Form
- Collateral Assignment Form
- Transfer of Collateral Assignment Form
- Change of Payee
- Co-Owner Change Form
- Pension Plan Verification Form
- Company, Partnership or LLC Verification Form
- Divorce Affidavit Form
Withdrawal Request Forms
- Withdrawal and Surrender Request – Annuity Contracts Only
- Withdrawal, Surrender and RMD -Pension Plan (does not include 403(b)/TSA)
- Systematic Withdrawal Request
- Required Minimum Distribution (RMD) Request
- Substantially Equal Periodic Payments under 72q and 72t
- TSA Withdrawal and Surrender Request
- TSA Loan Request
- Annuitize My Contract
- IRA Qualified Charitable Distribution Request
- Withholding Election Change Form
Transfer/Rollover Forms
- Change your existing 403(b)/TSA to a Traditional IRA
- Change your existing Traditional IRA to a SEP-IRA
- Change your existing Pension, Money Purchase, or Profit Sharing Plan to a Traditional IRA
- Change your existing SEP-IRA to a Traditional IRA
- Change your existing 401(k) to a Traditional IRA
- Convert your existing Traditional IRA to a Roth IRA
Your results...
Call 800-866-9933 to speak to a Protective Life Insurance customer service representative.
Your results...
Call 800-866-9933 to speak to a Protective Life Insurance customer service representative.
Your results...
Administrative Forms
- Address Change Form
- Name Change Form
- Authorize an Electronic Funds Transfer (EFT)
- Affidavit of Attorney-in-Fact
- Authorization to Release Policy Information
- Verification of Trust
Policy Change and Disbursement Forms
- Variable Universal Life Service Request Form
- Beneficiary Change Form
- Ownership Change Form
- Collateral Assignment of Life Insurance or Non-Qualified Annuity Form
- Transfer of Collateral Assignment
- Collateral Assignment Release
Your results...
Administrative Forms
- Authorize to release policy information
- Name Change Form
- Address Change Form
- Electronic Funds Deposit Authorization
- Affidavit of Power of Attorney
Policy Change Forms
- Clarity Variable Annuity Service Request Form
- Clarity 2+2 Variable Annuity Service request Form
- Change of Payee Form
- Change of Annuitant Form
- Beneficiary Change Form
- Owner Change Form
- Co-Owner Change Form
- Trust Verification Form
- Collateral Assignment Release Form
- Collateral Assignment Form
- Transfer of Collateral Assignment Form
- Pension Plan Verification Form
- Company, Partnership or LLC Verification Form
- Divorce Affidavit Form
Withdrawal Request Forms
- Variable Annuity Disbursement Request Form
- Annuitize my contract
- Make an IRA Qualified Charitable Distribution
Your results...
Administrative Forms
- Authorize to release policy information
- Name Change Form
- Address Change Form
- Electronic Funds Deposit Authorization
Policy Change Forms
- Change of Annuitant Form
- Beneficiary Change Form
- Owner Change Form
- Co-Owner Change Form
- Affidavit of Power of Attorney
- Change of Payee Form
- Trust Verification Form
- Pension Plan Verification Form
- Company, Partnership or LLC Verification Form
- Collateral Assignment Release Form
- Collateral Assignment Form
- Transfer of Collateral Assignment Form
- Divorce Affidavit Form
Withdrawal Request Forms
- Annuitize my contract
- Make an IRA Qualified Charitable Distribution
- Withdrawal and Surrender Request- Annuity Contracts Only
- Withdrawal, Surrender and RMD - Pension Plan (does not include 403(b)/TSA)
- Request a required minimum distribution
- Substantially Equal Periodic Payments under 72q & 72t
- Request withdrawal under Terminal Illness/Confinement Waiver
- Benefit 10 – Request withdrawal under Terminal Illness/Confinement
- Annuity Systematic Withdrawal Request
- Request to Begin, Suspend or Restart Income Rider Payments; Request to Terminate Income Rider
- Benefit 10 – Request to Begin, Suspend or Restart Income Rider Payments; Request to Terminate Income Rider
Transfer/Rollover Forms
Your results...
Administrative Forms
- Authorization to Release Policy Information
- Electronic Funds Deposit Authorization
- Affidavit of Power of Attorney
- Name Change Form
- Address Change Form
Policy Change Forms
- Collateral Assignment
- Collateral Assignment Release Form
- Transfer of Collateral Release Form
- Change of Payee
- Change of Annuitant Form
- Beneficiary Change Form
- Owner Change Form
- Co-Owner Change Form
- Trust Verification Form
- Pension Plan Verification Form
- Company, Partnership or LLC Verification Form
- Divorce Affidavit Form
Withdrawal Request Forms
- Withdrawal and Surrender Request – Annuity Contracts Only
- Withdrawal, Surrender and RMD -Pension Plan (does not include 403(b)/TSA)
- Systematic Withdrawal Request
- Substantially Equal Periodic Payments under 72q and 72t
- TSA Withdrawal and Surrender Request
- TSA Loan Request
- Required Minimum Distribution (RMD) Form
- Annuitize My Contract
- IRA Qualified Charitable Distribution Request
- Withholding Election Change Form
- TSA Loan Repayment Distribution Form
Transfer/Rollover Forms
- Change your existing 403(b)/TSA to a Traditional IRA
- Change your existing Traditional IRA to a SEP-IRA
- Change your existing Pension, Money Purchase, or Profit Sharing Plan to a Traditional IRA
- Change your existing SEP-IRA to a Traditional IRA
- Change your existing 401(k) to a Traditional IRA
- Convert your existing Traditional IRA to a Roth IRA
Your results...
Administrative Forms
- Address Change Form
- Name Change Form
- Power of Attorney Affidavit
- Authorization to Release Policy Information
- Trust Verification Form
Policy Change Forms
- Beneficiary Change Form
- Ownership Change Form
- Collateral Assignment of Life Insurance or Non-Qualified Annuity Form
- Transfer of Collateral Assignment
- Collateral Assignment Release
- Request for Policy Change
- Policy Change Flexible Premium Universal Life
- Request to Convert – Term Policy to Whole Life
- Request to Change to Extended Term or Reduced Paid Up
Withdrawal Forms
Your results...
Administrative Forms
- Electronic Funds Transfer (EFT) Authorization
- Electronic Funds Deposit Authorization
- Name Change Form
- Address Change Form
- Authorization to Release Information
- Affidavit of Power of Attorney
Policy Change Forms
- Change of Payee
- Beneficiary Change Form
- Change of Ownership Form
- Co-Owner Change Form
- Change of Annuitant Form
- Collateral Assignment
- Collateral Assignment Release Form
- Transfer of Collateral Assignment
- Trust Verification Form
- Pension Plan Varification Form
- Company, Partnership or LLC Verification Form
- Divorce Affidavit Form
Withdrawal Request Forms
- Required Minimum Distribution Package
- Annuity Substantially Equal Periodic Payments Under I.R.C. Sections 72(Q) and 72(T)
- Partial Withdrawal / Full Surrender Request
- Annuity Systematic Withdrawal Form
- Make an IRA Qualified Charitable Distribution
- Settlement Option Election Form
- Withdrawal and Surrender Request - Corporate Pension
- Athene Annuity & Life Assurance Company of New York Appendix 10A (Alternate 1)
- Athene Annuity & Life Assurance Company of New York Appendix 10B (Alternate 1)
- Athene Annuity & Life Assurance Company of New York Appendix 10C (Alternate 1)
- Athene Annuity & Life Assurance Company of New York Appendix 11 (Alternate 1)
- Request Partial Withdrawal or Full Surrender under Confinement Waiver or Terminal Illness Waiver
- Benefit 10- Request for Withdrawal under Terminal Illness or Confinement Provision
Transfer/Rollover Forms
- Internal Traditional IRA to Roth IRA Conversion
- Request to Transfer SEP-IRA to Traditional IRA
- Request to Transfer Traditional IRA to SEP-IRA
- Request to Transfer Qualified Plan to Qualified Plan
- Request to Rollover 403(b) TSA to Traditional IRA
Tax Forms
Your results...
Call 800-366-5463 to speak to a LifeCare Assurance Company customer service representative.
Claim Forms
For claim forms, call 800-800-9882 to speak with a customer service representative.
Contact Information
Mailing Address:
P.O. Box 1555
Des Moines, IA 50306-1555
Fax Number:
800-531-0038
Phone Number:
800-800-9882
Claim Forms
For claim forms, call 800-800-9882 to speak with a customer service representative.
Contact Information
Mailing Address:
P.O. Box 1555
Des Moines, IA 50306-1555
Fax Number:
800-531-0038
Phone Number:
800-800-9882
Contact Information
Mailing Address:
P.O. Box 1555
Des Moines, IA 50306-1555
Fax Number:
866-709-3922
Phone Number:
888-266-8489
Claim Forms
For claim forms, call 800-926-7599 to speak with a customer service representative.
Contact Information
Mailing Address:
PO Box 64269
St. Paul, MN 55164-0269
Fax Number:
855-893-5663
Phone Number:
800-926-7599
Claim Forms
For claim forms, call 800-234-5514 to speak with a customer service representative.
Contact Information
Mailing Address:
PO Box 64294
St. Paul, MN 55164-0294
Fax Number:
866-860-4024
Phone Number:
800-234-5514
Claim Forms
For claim forms, call 800-234-5514 to speak with a customer service representative.
Contact Information
Mailing Address:
PO Box 64294
St. Paul, MN 55164-0294
Fax Number:
866-860-4024
Phone Number:
800-234-5514
Claim Forms
For claim forms, call 800-423-9398 to speak with a customer service representative.
Contact Information
Mailing Address:
PO Box 64296
St. Paul, MN 55164-0296
Fax Number:
866-860-4024
Phone Number:
800-423-9398
Claim Forms
For claim forms, call 800-423-9398 to speak with a customer service representative.
Contact Information
Mailing Address:
PO Box 64296
St. Paul, MN 55164-0296
Fax Number:
866-860-4024
Phone Number:
800-423-9398
Claim Forms
For claim forms, call 866-690-1992 to speak with a customer service representative.
Contact Information
Mailing Address:
PO Box 725449
Atlanta, GA 31139
Fax Number:
770-690-1985
Phone Number:
866-690-1992
Contact Information
Mailing Address:
PO Box 64285
St. Paul, MN 55164-0285
Fax Number:
855-471-3817
Phone Number:
866-626-1161
Claim Forms
For claim forms, call 866-626-1161 to speak with a customer service representative.
Contact Information
Mailing Address:
PO Box 64285
St. Paul, MN 55164-0285
Fax Number:
855-471-3817
Phone Number:
866-626-1161
Claim Forms
For claim forms, call 800-926-7599 to speak with a customer service representative.
Contact Information
Mailing Address:
PO Box 64279
St. Paul, MN 55164-0279
Fax Number:
855-893-5662
Phone Number:
800-926-7599