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?

Annuity
Structured Settlement
Life Insurance
Accident & Health
Disability
Long Term Care
Accidental Death

What is the name of the issuing company listed on your contract or policy?

Athene Annuity and Life Company
(also formerly Aviva Life and Annuity Company, Athene Life Insurance Company of New York)
Athene Annuity & Life Assurance Company of New York
(also formerly Presidential Life Insurance Company)
Athene Annuity & Life Assurance Company
(also formerly Liberty Life Insurance Company, Investors Insurance Corporation, Magnolia Life, Southern Life, State National, Kentucky Central, RBC Insurance, Business Mens Assurance Company)

What type of life policy do you have?

Term, Traditional and Universal
Whole
Variable

What was the original issuing company of your policy?

Liberty Life, RBC Insurance or Business Mens Assurance Company
Liberty Life (Mortgage Term Life)

What was the original issuing company of your policy?

Magnolia Life, Southern Life, State National or Kentucky Central
Liberty Life, RBC Insurance or Business Mens Assurance Company

What is the name of the issuing company listed on your contract or policy?

Athene Annuity and Life Company
(also formerly Aviva Life and Annuity Company, Athene Life Insurance Company of New York)
Athene Annuity & Life Assurance Company of New York
(also formerly Presidential Life Insurance Company)
Athene Annuity & Life Assurance Company
(also formerly Liberty Life Insurance Company, Investors Insurance Corporation, Integon or Liberty Life Insurance Company, RBC Insurance, Business Mens Assurance Company)

What was the original issuing company of your policy?

Quincy
Other

Does your contract number begin with NY0, NY1 or 66?

Yes
No

Does your contract begin with:

VA01 or 05?
None of the above

What was the original issuing company name?

Investors Insurance Corporation
Integon, Liberty Life Insurance Company, RBC Insurance or Business Mens Assurance Company

What is the name of the issuing company listed on your contract or policy?

Athene Annuity and Life Company
(also formerly Aviva Life and Annuity Company, Athene Life Insurance Company of New York)
Athene Annuity & Life Assurance Company
(also formerly Liberty Life Insurance Company, Investors Insurance Corporation, Integon or Liberty Life Insurance Company, RBC Insurance, Business Mens Assurance Company)

What is the name of the issuing company listed on your contract or policy?

Your results...

Call 855-615-2276 to speak to a customer service representative.

Your results...

Call 877-462-8992 to speak to a 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
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

W-9 Taxpayer ID Form

Buyer's Guides

Annuity Buyer's Guide
Annuity Buyer's Guide - KY
Annuity Buyer's Guide - WI

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...

Call 800-926-7599 to speak to a customer service representative.

Your results...

Call 800-866-9933 to speak to a 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

Convert my existing traditional IRA to a Roth IRA
Transfer funds from Employee Retirement Plan
Traditional-IRA to Roth-IRA Conversion
1035 Exchange/Absolute Assignment

Your results...

Call 800-234-5514 to speak to a customer service representative.

Your results...

Call 800-423-9398 to speak to a customer service representative.

Your results...

Call 866-626-1161 to speak to a customer service representative.

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 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

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

Election of Withholding

Your results...

Call 800-366-5463 to speak to a customer service representative.

Your results...

Service Forms

Address Change Request
Beneficiary Change Request
Electronic Funds Transfer (EFT) Authorization
Authorization to Release Information
Name Change Request

Claim Forms

For claim forms, call 800-800-9882 to sp eak 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 800-234-5514 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 888-266-8489 to speak with a customer service representative.

Contact Information

Mailing Address:

7700 Mills Civic Parkway
West Des Moines, IA 50266

Fax Number:
866-709-3922

Phone Number:
888-266-8489

Contact Information

Mailing Address:

P.O. Box 1555
Des Moines, IA 50306-1555

Overnight Mailing Address:

7700 Mills Civic Parkway
West Des Moines, IA 50266-3862

Fax Number:
866-709-3922

Phone Number:
800-525-7133

Service Forms

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 NY0, 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?

Your results...

Your results...

Your results...

Administrative Forms

Policy Change Forms

Withdrawal Request Forms

Tax Forms

Buyer's Guides

Claim Forms

Your results...

Your results...

Your results...

Your results...

Administrative Forms

Policy Change Forms

Withdrawal Request Forms

Transfer/Rollover Forms

Your results...

Your results...

Your results...

Your results...

Administrative Forms

Policy Change Forms

Withdrawal Request Forms

Transfer/Rollover Forms

Tax Forms

Your results...

Your results...

Service Forms

Claim Forms

Contact Information

Contact Information

Claim Forms

Contact Information

Claim Forms

Contact Information

Contact Information

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