ANICO

ANNUITY

• 10585-PR-Allocation (PDF)
• Absolute Assignment (PDF)
• Annuity Claim (PDF)
• Annuity Service Request (PDF)
• Deceased Ownership Change (PDF)
• Deduction Monthly Premiums from Salary 971 (PDF)
• Lifetime Income Rider Request (PDF)
• NON-ADMIN GROUP CONTRACT DISTRIBUTION REQUEST (QUALIFIED ANNUITY) (PDF)
• Pre 59 age Distribution Request (PDF)
• Premium Allocation Change ASIA 7 & 10
• Request for Confinement, Disability or Terminal Illness Waiver Facility (PDF)
• Request for Confinement, Disability or Terminal Illness Waiver Owner (PDF)
• Request for Confinement, Disability or Terminal Illness Waiver Physician (PDF)
• Request for Payment of Settlement Option AN-10905
• Suitability-USA Patriot Act (PDF)
• Summary and Disclosure Notice for Accelerated Benefits (PDF)
• Transfer 1035 and Non Qualified (PDF)
• Transfer or Rollover Qualified Request (PDF)
• Waiver of Administrative Services (PDF)
• WealthQuest Series - Additional Payment Receipt - 4729 (PDF)

LIFE

• Absolute Assignment (PDF)
• Additional Beneficiary for Inforce Policies (PDF)
• Address-Contact Change and Policy Duplicate AN-11090 (PDF)
• ANICO Change of Agent (DOCX)
• Application for Policy Change (Term Conversion) (PDF)
• Application for Reinstatement ICC09582 (PDF)
• Beneficiary Change Request (PDF)
• Change of Ownership (PDF)
• Claim for Chronic Illness - Statement of Claimant (DOC)
• Claim Form for Chronic Illness Acc Ben Phy Statement (DOC)
• Collateral Assigment - AN331 (PDF)
• Death Claim AN536 (PDF)
• Declaration of Insurability (Increase IUL) (PDF)
• Deduction Monthly Premiums from Salary 971 (PDF)
• Payroll Deduction  969 (PDF)
• Policy Change Application - 11197 (PDF)
• Policy Loan or Cash Surrender Request AN-11114 (PDF)
• Policy Service Request AN11091 (PDF)
• Pre-Authorize Payment Plan Form 2011 (PDF)
• Transfer 1035 and Non Qualified  4394NQ (PDF)
• Transfer or Rollover Qualified Request 4394Q (PDF)

BRIGHTHOUSE

• Change of Beneficiary (PDF)
• Collateral Assignment (PDF)
• Full Surrender Request (PDF)
• Name Change (PDF)
• Partial Cash Withdrawal Request (PDF)
• Policy Loan Request (PDF)
• Release Collateral Assignment (PDF)

Fidelity & Guaranty

• 1035 Exchange Transfer - Rollover (PDF)
• Change Beneficiary Request (PDF)
• Change Name or Address (PDF)
• Claimant's Statement- Annuity (Non-Qualified) (Deceased) (PDF)
• Contract Change - Transfer of ownership (PDF)
• Distribution Request By Beneficiary (PDF)
• Duplicate Policy Request (PDF)
• Fidelity Change of Agent (DOCX)
• Loan Request
• PAC admin5617
• Request for disbursement form Qualified Annuities (all Non-NY States) (PDF)
• Request for Disbursement - Non-Qualified Annuities (PDF)
• Request for Disbursement TSA
• Signature Verification Form (PDF)
• Transfer of Ownership-Beneficiary
• W-9 Request Taxpayer Identification Number and Certification (PDF)

John Hancock

• Collateral Assignment-Release Collateral (PDF)

Lincoln Financial Group

ANNUITY

• 1035 Exchange-Rollover (PDF)
• Additional Deposit
• Annuity Automatic  Withdrawal Non Qualified (PDF)
• Annuity Change Broker-Representative (PDF)
• Automatic Bank Draft (PDF)
• Certification of Trustee Powers (PDF)
• Change of Agent (PDF)
• Change of Ownership for Annuity (PDF)
• Change Beneficiary (PDF)
• CLAIMANT'S STATEMENT UP LIFE DEATH (PDF)
• Collateral Assignment Life or Annuity (PDF)
• Contract Change Request (PDF)
• DECEASED CONTRACT REQUEST (PDF)
• Direct Deposit Authorization (EFT) (PDF)
• Distribution Request - Guaranteed Lifetime Withdrawal Benefit Rider (PDF)
• Distribution Request - NONQUALIFIED NOT LIVING BENEFITS (PDF)
• Non Qualified Claimant's Statement (PDF)
• Producer Information Change (PDF)
• Release Collateral Assignment Life or Annuity (PDF)
• Repayment of Coronavirus Related Distributions (PDF)
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LIFE

• 1035 Exchange (PDF)
• Agent Change (PDF)
• Allocation Change or Transfer Request (PDF)
• Application for Conversion-PR (PDF)
• Beneficiary Change for Life (PDF)
• Cancel Letter 1035 (DOC)
• Collateral Assignment Life or Annuity (PDF)
• Contract Change Request (PDF)
• Life Address Change Form (PDF)
• Loan Request (PDF)
• Lost Policy - Duplicado de Póliza (PDF)
• Name Change (PDF)
• Ownership Change - Life (PDF)
• PAC Electronic Fund Transf. Auth. (PDF)
• Partial Surrender or Withdrawal - Life (PDF)
• Premium Deposit Fund Transmittal (PDF)
• Producer Information Change (PDF)
• Reinstatement or Change App (PDF)
• Release Collateral Assignment Life or Annuity (PDF)
• Release Collateral Life or Annuity (PDF)
• Request for Partial-Withdrawal
• Surrender Request - Life (PDF)
• Systematic Disbursements (PDF)
• Term Cancellation Request (PDF)

Mass Mutual

• EFT (PAC) (PDF)

National Western

• Additional Beneficiary (PDF)
• Address Change Request (PDF)
• Annuity Death Claim (PDF)
• Assignment Policy as Collateral (PDF)
• Change of Beneficiary (PDF)
• Direct Deposit Request (PDF)
• Early Distribution (PDF)
• Early Distribution Transfer (PDF)
• Minimum Distribution Disclosure Age 70 and Older (PDF)
• Partial Surrender (PDF)
• Policy Owner Change Request (PDF)
• Request for Systematic Withdrawal of Interest (PDF)
• Request Q-NQ Spousal Continuation (PDF)
• Request Systematic Payment (PDF)
• Request Systematic Payment under Rider (PDF)
• Surrender Form (PDF)
• Systematic Payment Penalty Free (PDF)
• W-9 Identification Form (PDF)

Ohio National

• Consentimiento de declinación del cliente (PDF)

Protective

• Allocation Change (PDF)
• Application for Conversion or Exchange (PDF)
• Assignment Transfer (PDF)
• Automatic Premium Loan (PDF)
• Beneficiary Change (PDF)
• Change of Name (PDF)
• Collateral Assignment (PDF)
• Duplicate Policy (Policy Lost) (PDF)
• Duplicate Policy (Policy Not Lost) (PDF)
• Loan Request (PDF)
• Partial Assignment of Policy as Collateral (PDF)
• Partial Surrender (PDF)
• Pre-Authorized Withdrawal (PDF)
• Reinstatement for PR (PDF)
• Service Request (PDF)

Universal Life

• Additional Premium Equity Index & Equity Index Bonus (PDF)
• Agent Name (PDF)
• Aportación Adicional Anualidad e IRA (PDF)
• Contract Change Request (PDF)
• Death Benefit Election (PDF)
• Emergency Withdrawal Form (PDF)
• Formulario de Retiro Declaración Emergencia Huracán Fiona
• Withdrawal Form - Fixed and Equity Contracts (PDF)

OTROS

• Acuerdo de Confidencialidad General (Fillable PDF)
• CANCELACIÓN TERM (DOCX)
• Carta Cancelación de Annuity (DOCX)
• Carta Cancelación de Pólizas (DOCX)
• Carta Cancelación Descuento Sueldo Póliza (DOCX)
• Change of Agent (DOCX)
• COVID-19 CARTA PARA CESAR PRIMAS (DOCX)
• Directorio Servicio al Cliente (PDF)
• Disablity Insurance Proposal Request (Fillable PDF)
• Life & Annuity Proposal Request (Fillable PDF)
• Quick App Annuity (Fillable PDF)
• Quick App IRA (Fillable PDF)
• Quick App Life (Fillable PDF)
• Requisitos Reactivación & Licencia Nuevas OCS (PDF)
• Requisitos Renovación de Licencia OCS (PDF)