For some contracts, withdrawals taken may be subject to an MVA adjustment. signNow combines ease of use, affordability and security in one online tool, all without forcing extra DDD on you. The option is available to have your long-term care policy premiums deducted directly from your checking or savings The total distribution amount will be reported in Box 1 (gross distribution), the taxable portion of the distribution will be reported in Box 2a (taxable amount), and the amount of after-tax contribution (cost basis) will be reported in Box 5. What portion of my death benefit is taxable? Upon receipt of the completed claim form packet and certified death certificate, the Allianz Claims department will evaluate your claim within 10 business days (or within applicable state requirements). After January 31, you can check to see if your statement is also available online by registering or logging in to your account and going to "Current Statements." You will need to verify your name, Social Security number, and date of birth. We will contact the beneficiary for additional information if needed. I did a 1035 exchange of my nonqualified annuity or life insurance policy. Email Get Form. Surrender approved (Approved within 4 working days for standard cases) Surrender payout via e-Payment (Payout within 5 working days). What if my employer is able to make a SEP IRA contribution for 2022 in 2023? When logged into your account, you can make changes to your contract allocations and beneficiary. To get started on the form, use the Fill & Sign Online button or tick the preview image of the blank. Choose My Signature. Yes, if a claim isn't filed within a certain number of years it is considered unclaimed property and would be sent to the state in accordance with applicable state requirements. Application for Child Care Benefits - Ohio Department of Job and - jfs ohio. Save time and skip the bank line by signing up for direct deposit for one-time and recurring withdrawals. Claim managemnet Liability Form. This date is always subject to change by the U.S. Department of the Treasury; we encourage you to speak with your tax professional if you have questions about your due date. Why is the total distribution amount reported in Box 1 (gross distribution)? Upon receipt of the required documents, we will process your claim within 10 business days or within the applicable state requirements. How can I avoid potential policy issues related to mail delivery delays? Our highest priority is the health and well-being of our customers, partners, and employees during these extraordinary times. The advanced tools of the editor will direct you through the editable PDF template. PO Box 1344 Typically, the Fair Market Value (FMV) in Box 5 is the only information provided. To submit a request for an eligibility determination, a claim form and additional information is required to initiate this You may also be able to request a withdrawal or schedule a required minimum distribution (RMD) payment stream. 0 share; SHARE ON TWITTER; Share on Facebook return completed form to: claims department/2700 west plano parkway/plano, tx 75075 800.251.7254/ FAX: 866.586.6528 - - Male Female Allianz uses disclosure documents to help inform you of the costs and benefits of each product before you buy and thats why we give you time to examine the product and cancel it for a full refund. ", First log in, then click on the policy or contract number(s) displayed under "My Account. This checklist does not, This document outlines the forms that are necessary to file a new claim under your SHIP long-term care policy and, This form is designed to help you stay organized while submitting a new nursing facility claim. By completing and, This form is provided for your convenience in the event your home health care provider does not have their own daily, This form is designed to help you stay organized while submitting a new home health care claim. Long-term disability LTD benefits replace 66 23 of your base monthly. This includes the potential cancellation or nonrenewal of policies due to nonpayment of premium. PO Box 561 Please consult a tax professional to determine this amount. A loan from a nonqualified annuity is considered a taxable event (if there were gains in the contract up to the amount of the loan), even if it was paid back in the same year. This form is designed to help you stay organized while submitting a new home health care claim. If you choose to assign your long-term care insurance benefits to a covered provider, you must submit the Direction to Minneapolis, MN 55440-0561. (typically, consisting of 3 to 9 members). Mail A death claim requires the beneficiary to complete and return the claim form packet with one copy of the certified death certificate. I own a trust can I create an account online? Allianz Life Insurance Company of North America Monday Thursday If you are covered by our International Healthcare Plans for Mexico, use this form to claim back eligible medical expenses. calpers long term form one-size-fits-all solution to design calpers continued monthly residence form? Open them in the editor, fill out, e-sign, and share them right from your browser. If you own an Allianz policy or contract, you can register for online access. After the taxable amount is reported to you as income, you will not be taxed on this amount again when annuity payments begin; instead, only earnings from the annuity payments will be taxable each year. Please consult a tax advisor on specifics regarding contributions for Traditional IRAs, Roth IRAs, SEP IRAs, and SIMPLE IRAs. If the annuity contract is anon-tax-qualifiedannuity, any amount over the owner's cost basis (generally the after-tax contributions that were made by the owner) in the contract is taxable as ordinary income. Email fixedannuity@send.allianzlife.com Different rules apply to Roth IRAs. ABC Lifetime Withdrawal Election Form - S2301. If this form is not submitted with your claim form it may delay our handling of your claim. Claim Professional realestate Form. The CMR form must be completed for facility claims by an authorized representative of the facility on a monthly basis and submitted with the bill(s) after the end of each month. Contact your state insurance departmentto make sure he or she is properly licensed, or go online to BrokerCheck atwww.finra.orgto learn more about your registered representative. If you are covered by one of the International Healthcare Plans for Egypt, use this form to claim back eligible medical expenses. Once youve received your claim form packet, please complete and return it to us at: Fixed Annuities and Life Insurance Policies: Allianz Life Insurance Company of North America Life insurance: Producer Services 763.582.6005, To change your account allocation, log inand go to " Personal Accounts. I certify that to the best of my knowledge this Claim Form does not contain any false misleading or incomplete information. If you would like your contribution to be recorded for the 2022 tax year, please write 2022 contribution on your check. ABC Qualified Plan Acknowledgement Form and ERISA Disclosure - ABC-ERPOS. Allianz does not issue any tax reporting on custodial IRAs or qualified plans such as pension plans, Keoghs, 401(k) plans, or defined benefit plans. This box is also generally checked for a distribution from an IRA (Traditional, SEP, SIMPLE or Roth). The Direction to Pay form is provided as a convenience to our policyholders and their care providers ", Beneficiary changes can be made online. How is Allianz helping those impacted by COVID-19? I understand that in the event. Tax forms will be sent to the beneficiary in the year following payment if applicable. Get the Senior Health Insurance Company Pennsylvania Continued Monthly Residence Form you want. Edit your form settlement option online Type text, add images, blackout confidential details, add comments, highlights and more. All you need is smooth internet connection and a device to work on. If you click a merchant link and buy a product or service on their website, we may be paid a fee by the merchant. Independently verify the identity of any company, charity, or individual that contacts you regarding COVID-19. Why did I get this? How do I know if a Required Minimum Distribution (RMD) is needed from my contract? Send allianz beneficiary forms nb6059 via email, link, or fax. Variable annuities variableannuity@send.allianzlife.com For those born in 1951, their first RMD will not be due until they turn age 73. If you are covered by one of the International Healthcare Plans for Vietnam, choose the relevant form below to claim back eligible medical expenses. Why does the Form 5498 show no contributions? Please read the "To File a Claim" instructions included in the Claim Information Package. Use professional pre-built templates to fill in and sign documents online faster. Requests for a withdrawal from a fixed annuity can be made online. Requests to take the required minimum distribution from a fixed annuity can be made online. 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. By registering your account online, you will have access to contract values, statements, the ability to change allocations, and access to yearly tax statements. Variable annuities 763.765.7912 Upon receipt of the completed claim form packet and certified death certificate, the Allianz Claims department will evaluate your claim within 10 business days (or within applicable state requirements). In addition, we continue to identify and provide new tools and technologies to help us stay connected with each other and our customers. Life insurance 763.582.6002 4 hours ago Insurance benefits underwritten by BCS Insurance Company or Jefferson Insurance Company, depending on insureds state of residence and plan type. Depending on the option selected, payment will be sent to the beneficiary. 50 of the value of the food - Oaks Amusement Park, Gift Forms And Functions Exchang - ShopAmericaNG, CAMP CLARK WILLIAMSON FACILITY & GROUNDS USE POLICY. These transactions typically include, but are not limited to: For a nonqualified annuity, Allianz did not receive the after-tax contribution (cost basis) information from the previous company. You can also reach out to your financial professional to assist you in setting up RMD. Pay form to SHIP. Upon receipt of the required documents, we will process your claim within 10 business days or within the applicable state requirements. : (886) 2 8770 9888 Fax : 0800 088 112 . Allianz Life Insurance Company of North America (Allianz), its affiliated companies, and their representatives and employees do not provide legal or tax advice. Fixed annuities 763.582.6002 Can I surrender my Bajaj Allianz policy online? : Contract/Warranty Not applicable. Claim Professional largelawfarmprofliability Form. File a travel insurance claim online 24/7 with Allianz Global Assistance. What steps can I take to help protect myself from fraud and scams related to COVID-19? If your first non-tax-qualified annuity payment is issued after one year from the date of death, the following will occur: We will report the entire taxable portion of the death benefit in the year in which the first payment is made. If you are covered by our International Healthcare Plans for Hong Kong, use this form to claim back eligible medical expenses. You can begin the claims process online or by contacting us by phone. Form 5498 is also used to report the year-end Fair Market Value information for your annuity. View More. Surrender Value: The Policy can be surrendered provided three full years premiums have been paid. The RMD Election Form is provided below under the section titled Forms.. Click the Start a claim button to start the claims process. Log into your account to upload the completed form. The surrender value is paid to the policyholder at the time of surrender. What is the amount that I am allowed to contribute to my Traditional IRA and/or Roth IRA for year 2022? Minneapolis, MN 55440-0561 If you choose to assign your long-term care insurance benefits to your covered provider, this form is required from your Get Form. We quickly transitioned into a work-from-home environment with the majority of our employees working remotely. How do I know if Im scheduled for an RMD distribution? If you received distributions from multiple contracts, you will get a 1099-R for each contract. allianz form s2043 allianz form s2043 allianz s2043 download allianz form s2071 allianz company form Allianz Life Insurance Company of North America PO Box 59060 Minneapolis, , See Also: Allianz long term care formsVerify It Show details, 6 hours ago Related to allianz life insuranc company of north america continued monthly residence form allianz company form Allianz Life Insurance Company of North America PO Box 59060 Minneapolis, MN 554590060 Phone: 800.950.1962 Fax: , See Also: Ship continued monthly residence formVerify It Show details. PO Box 59060 How do I request a withdrawal from my annuity contract or life insurance policy? A transfer is not reported on a 5498 Form. Thats why weve designed our claims process in three steps so you can focus on what matters most. This form is required to recognize and work with deponents as the sole, legal, equitable, and unrestricted heirs to the, Due to HIPAA regulations, we are unable to release your personal information without your authorization. Life insurance lifeinsurance@send.allianzlife.com, Mail You should consult a tax professional for information on the proper income tax reporting of a rollover from an IRA. Distributions (e.g., required minimum distributions, loans from nonqualified annuities, full or partial surrenders, annuitization payments, and annuity claim proceeds). If the annuity contract is atax-qualified annuity, such as an IRA, the entire amount of the death benefit will generally be fully taxable. Allianz 222 Annuity Disclosure - 222-DISC-NJ [NJ] Manage Your Policy/Contract Online Change your address, billing info, automate payments and more. Producer services 763.582.6005. Allianz 222 Annuity provides the typical features of fixed index annuities including principal protection from market downturns, the potential for tax-deferred growth, options for lifetime retirement income, and a death benefit for your beneficiaries. What should I do if I suspect fraud related to COVID-19? Upon receipt, the Allianz Claims department will evaluate your claim within 10 business days. Life insurance 763.582.6002 Past statements on active Allianz policies and contracts are available online. How can I take the required minimum distribution (RMD) from my policy or contract? Apt. Allianz Life Insurance Company of North America 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. PO Box 561 4. Last name Spouse s rst name only if married ling jointly Taxpayer s Social Security Our surrender process: Submit complete document to Allianz Life branch. to assign benefits to the care provider, but not the rights under the policy. Reminder: If you complete an IRA-to-IRA indirect rollover, you generally cannot, within a 12-month period from the date you received the distribution, make another indirect rollover of a distribution from any of your IRAs to another IRA. process. Log inand go to "Personal Accounts.. Log inand go to "Personal Accounts. 2019 Daily-catalog.com. Box 2a will be blank to show that this is nontaxable. There are three variants; a typed, drawn or uploaded signature. The general limit the most that can be contributed to your Traditional IRA and/or Roth IRA is the lesser of the following amounts: $6,000.00 ($7,000.00 if you are age 50 or older) or your earned income for the year. We will be looking into this with the utmost urgency, The requested file was not found on our document library. Know your salesperson before you buy any financial product. Enter your official contact and identification details. What measures does Allianz have in place to help protect me from fraud? Agent/Rep Change of Address Form - M1217. Find the right form for you and fill it out: No results. If you are covered by one of the International Healthcare Plans for Qatar, use this form to claim back eligible medical expenses. There are some steps you can take to help prevent this from happening to you: To help protect you from fraud, Allianz provides periodic statements of your products activity. The mailing address and fax number are provided on the form for your convenience. Fixed annuities 763.582.6002 As a reminder, under the SECURE Act of 2019 individuals turning age 70 in 2020 are not required to begin taking RMDs until the year of attaining age 72 (first RMD due by April 1 of the year following the year of attaining age 72). If you have registered for an online account, you may have the ability to request RMD payments online by logging into your secure account through our website. , 10476 378 5 Tel . The group can be covered for single or multiple trips to the region where the healthcare plan is held for up to or a combined maximum of either: 90 travel days per insurance year each. Please check your spelling or try another term. You will also need to complete Section 5 tax withholding information if you wish to elect out of federal tax withholding. 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. Please contact customer service at (800) 621-3724 (800) 525-7662 for assistance. . Use a check mark to point the choice wherever expected, See Also: Allianz ltc claim forms Show details, 2 hours ago If you are covered by one of our GlobalPass plans for Latin America, choose the relevant form below to claim back eligible medical expenses. Investor Education. Complete the quick two-step registration process to access your Allianz account online. If you are covered by our International Healthcare Plans for Lebanon, use this form to claim back eligible medical expenses that occurred outside of Lebanon. We will mail Form 1099-R by January 31, 2023. If your Traditional or Roth IRA contract allows for additional premium, your contribution must be sent to a company-approved mailing address and postmarked by the due date for filing your return for that year, not including extensions. You can also find past premium payment information by registering or logging in to our website. This checklist does not Complete a form for each month, on or after the last , See Also: Allianz life insurance forms Show details, 7 hours ago ALLIANZ LIFE Forms . SEP IRA contributions Allianz receives in 2023 will be reported on the 2023 Form 5498, even when the employer deducts the SEP contribution on their 2022 tax return. Complete each fillable area. Claim Healthcare Form. Just Now allianz continued monthly residence form. Agent Agreement - M1087. Claim Form for individual members. This document outlines the forms that are necessary to file a new claim under your SHIP long-term care policy and June 29, 2022. If Allianz did not receive transfer paperwork and a letter of acceptance from the other company, even if the check was made payable to the other company, we report the transaction because we do not have confirmation that the distribution went directly to an IRA at another company. Representative must be appointed with Allianz Life Insurance Company of North America. The 1099-R is the supporting document to show the amount of gains and the cost basis amount, if known, that were sent to the other company. Direction to Pay Any determination that is to be made, such as to policy values, beneficiary, claim eligibility, or policy status, will take place. If the distribution did go directly to an IRA at another company, please provide us with confirmation of this from the receiving company. A new withdrawal form is required with each request. Create this form in 5 minutes! 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. Agent Report - NB5029-EN-5. It may be necessary for us to request additional information to reach an eligibility determination. My contract is annuitized; why am I receiving this annual tax summary? 1 hours ago The IRS requires the use of specific distribution codes for different types of payments, which need to be reported separately. Just Now For Taiwan Investors only Allianz Global Investo rs Taiwan Limited, 5F, No. Complete the blank fields; involved parties names, places of residence and phone numbers etc. Prudential Global Beneficiary Designation Form. Many updates and improvements! How does Allianz ensure that my best interests are protected when purchasing an annuity or life insurance? The display of third-party trademarks and trade names on this site does not necessarily indicate any affiliation or endorsement of daily-catalog.com. Log inand go to "Personal Accounts.". To request your RMD withdrawal, please download and complete the form associated with your contract or policy andlog into upload the completed form. Dochub is the best editor for changing your forms online. 6 hours ago Fund Literature. How can I find my policy or contract value? DocHub v5.1.1 Released! Get access to thousands of forms. How can I verify that my financial professional is properly qualified and licensed? Type text, add images, blackout confidential details, add comments, highlights and more. Transfer Ownership and/or Change Beneficiaries. Note: As part of SECURE 2.0 Act of 2022, signed into law on December 29, 2022, the RMD age is changing for people who were born in 1951 or later. Get this form now! Decide on what kind of signature to create. If I want to elect annuitization payments to receive the death benefit, are there any time periods I need to be concerned with? If you will receive the first payment outside of these timeframes, contact us to discuss your specific situation. By using this site you agree to our use of cookies as described in our, allianz authorization to transfer funds form, allianz withdrawal request form for annuity contract. Keep proof of payment/mailing. RMD information is displayed on the Policy Detail screen under Accounts. We strongly encourage all customers to consult their financial professionals about their unique personal needs and situation. If you have registered for an online account, this information can be found by logging in to our secured website. progress notes or billing forms. Share your form with others Send allianz form s2043 via email, link, or fax. Im a beneficiary can I create an account online? Allianz Life Insurance Company of North America If you believe that this page should be taken down, please follow our DMCA take down process here. explains the time frames associated with filing a new claim. The death benefit is generally not taxable to the beneficiary. My employer made contributions to a SEP IRA. Be wary of unsolicited emails offering information, supplies, or treatment for COVID-19 or requesting your personal information for medical purposes. Refer to the claim form packet to learn what is available. How do I access my policy or contract online? Make a phone payment. O. We encourage all clients to plan ahead to avoid delays with physical mail that could negatively impact your life insurance policy. If you would, The option is available to have your long-term care policy premiums deducted directly from your checking or savings, To submit a request for an eligibility determination, a claim form and additional information is required to initiate this, The claim information package contains the documents to explain the claim filing process and the forms you may need, If you choose to assign your long-term care insurance benefits to a covered provider, you must submit the Direction to, It may be necessary for us to request additional information to reach an eligibility determination. Minneapolis, MN 55459-0060, Variable and index variable annuities Original forms cannot be modified and resubmitted. 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 - 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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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