Search

Get Started

TRADITIONAL LIFE INSURANCE, ANNUITIES, AND FIXED DEFERRED ANNUITIES

Service Forms

The best way to fill out or make changes to your forms is our Self-Service channel on my account. If you need further assistance, we recommend calling our Customer Service Center.

Traditional Life Insurance & Annuities

Self-Service

Call-Us

Form

My Payment Preferences Form

 

Use this form to set up a payment arrangement in which premiums are paid monthly by automatically deducting the money directly from your checking or savings account.

Login

Call Us: 1-800-225-5695

Fax number: (800) 278-4117

Download

 

Mailing address:
New York Life Insurance Company
Dallas Service Center
P.O. Box 130539
Dallas, TX 75313

Change of Beneficiary Form

 

Use this form to change your beneficiary if your policy is a family plan or if it has rider insureds.

Login

Call Us: 1-800-225-5695

Fax number: (800) 278-4117

Download

 

Mailing address:
New York Life Insurance Company
Dallas Service Center
P.O. Box 130539
Dallas, TX 75313

Transfer of Ownership / Designation of Successor Owner Form

 

Use this form to make the most standard transfer of ownership requests.

Call Us: 1-800-225-5695

Fax number: (800) 278-4117

Download

 

Mailing address:
New York Life Insurance Company
Dallas Service Center
P.O. Box 130539
Dallas, TX 75313

Transfer of Ownership Kit

 

Use this kit to transfer ownership, setup a Check-O-Matic arrangement to pay your premiums, and change your beneficiary.

Call Us: 1-800-225-5695

Fax number: (800) 278-4117

Download

 

Mailing address:
New York Life Insurance Company
Dallas Service Center
P.O. Box 130539
Dallas, TX 75313

Loan Form

 

Use this form to request a loan against the cash value of your policy, while still maintaining your insurance coverage.

Login

Call Us: 1-800-225-5695

Fax number: (800) 278-4117

Download

 

Mailing address:
New York Life Insurance Company
Dallas Service Center
P.O. Box 130539
Dallas, TX 75313

Loan repayments via automatic payment arrangement

 

Use this form to set up a payment arrangement in which loan repayments are paid monthly by automatically deducting the money directly from your checking account.

Login

Call Us: 1-800-225-5695

Fax number: (800) 278-4117

Download

 

Mailing address:
New York Life Insurance Company
Dallas Service Center
P.O. Box 130539
Dallas, TX 75313

Partial Withdrawal Request Form

 

Use this form to request a partial withdrawal from your Target, Universal, or Annuity policies.

Login

Call Us: 1-800-225-5695

Fax number: (800) 278-4117

Download

 

Mailing address:
New York Life Insurance Company
Dallas Service Center
P.O. Box 130539
Dallas, TX 75313

Statement of Trust Form

 

Use this form to change the beneficiary or ownership of your policy to a Trust.

Login

Call Us: 1-800-225-5695

Fax number: (800) 278-4117

Download

 

Mailing address:
New York Life Insurance Company
Dallas Service Center
P.O. Box 130539
Dallas, TX 75313

Dividend Withdrawal Form

 

Use this form to withdraw dividends from your policy.

Login

Call Us: 1-800-225-5695

Fax number: (800) 278-4117

Download

 

Mailing address:
New York Life Insurance Company
Dallas Service Center
P.O. Box 130539
Dallas, TX 75313

Name Change Request Form

 

Use this form to process a change of Name on your policy.

Call Us: 1-800-225-5695

Fax number: (800) 278-4117

Download

 

Mailing address:
New York Life Insurance Company
Dallas Service Center
P.O. Box 130539
Dallas, TX 75313

If you are a US person, use this form to: certify that the Taxpayer Identification Number (TIN) you are giving is correct (or you are waiting for a number to be issued); certify that you are not subject to backup withholding; or claim exemption from backup withholding if you are a U.S. exempt payee

IRS Form W-4P - Withholding Certificate for Pension or Annuity Payments

 

If you are a US person, use this form for all annuity contracts and annuity death claims.

Fax number: (800) 278-4117

Download

 

Mailing address:
New York Life Insurance Company
Dallas Service Center
P.O. Box 130539
Dallas, TX 75313

IRS Form W-9 - Request for Taxpayer Identification Number and Certification

Fax number: (800) 278-4117

Download

 

Mailing address:
New York Life Insurance Company
Dallas Service Center
P.O. Box 130539
Dallas, TX 75313

IRS Form W-8BEN - Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding (Individuals)

Fax number: (800) 278-4117

Download

 

Mailing address:
New York Life Insurance Company
Dallas Service Center
P.O. Box 130539
Dallas, TX 75313

Instructions for the Form W-8BEN

 

Instructions to complete the IRS Form W-8BEN.

Fax number: (800) 278-4117

Download

 

Mailing address:
New York Life Insurance Company
Dallas Service Center
P.O. Box 130539
Dallas, TX 75313

IRS Form W-8BEN-E - Certificate of Status of Beneficial Owner for United States Tax Withholding and Reporting (Entities)

Fax number: (800) 278-4117

Download

 

Mailing address:
New York Life Insurance Company
Dallas Service Center
P.O. Box 130539
Dallas, TX 75313

Instructions for the Form W-8BEN- E

 

Instructions to complete the IRS Form W-8BEN-E.

Fax number: (800) 278-4117

Download

 

Mailing address:
New York Life Insurance Company
Dallas Service Center
P.O. Box 130539
Dallas, TX 75313

IRS Form W-8ECI - Certificate of Foreign Person"s Claim

 

That Income Is Effectively Connected With the Conduct of a Trade or Business in the United States

Fax number: (800) 278-4117

Download

 

Mailing address:
New York Life Insurance Company
Dallas Service Center
P.O. Box 130539
Dallas, TX 75313

Instructions for the Form W- 8ECI

 

Instructions to complete the IRS Form W-8ECI.

Fax number: (800) 278-4117

Download

 

Mailing address:
New York Life Insurance Company
Dallas Service Center
P.O. Box 130539
Dallas, TX 75313

IRS Form W-8EXP - Certificate of Foreign Government or Other Foreign Organization for United States Tax Withholding and Reporting

Fax number: (800) 278-4117

Download

 

Mailing address:
New York Life Insurance Company
Dallas Service Center
P.O. Box 130539
Dallas, TX 75313

Instructions for the Form W- 8EXP

 

Instructions to complete the IRS Form W-8EXP.

Fax number: (800) 278-4117

Download

 

Mailing address:
New York Life Insurance Company
Dallas Service Center
P.O. Box 130539
Dallas, TX 75313

IRS Form W-8IMY - Certificate of Foreign Intermediary, Foreign Flow-Through Entity, or Certain U.S. Branches for United States Tax Withholding and Reporting

Fax number: (800) 278-4117

Download

 

Mailing address:
New York Life Insurance Company
Dallas Service Center
P.O. Box 130539
Dallas, TX 75313

Instructions for the Form W- 8IMY

Fax number: (800) 278-4117

Download

 

Mailing address:
New York Life Insurance Company
Dallas Service Center
P.O. Box 130539
Dallas, TX 75313

Fixed Deferred Annuities

Call-Us

Form

Policy Change Request Form

Fax number: (800) 278-4117

Download

 

Mailing address:
New York Life Insurance Company
Dallas Service Center
P.O. Box 130539
Dallas, TX 75313

Clear Income FDA Withdrawal Form (covers PWs, PPWs and surrenders)

Fax number: (800) 278-4117

Download

 

Mailing address:
New York Life Insurance Company
Dallas Service Center
P.O. Box 130539
Dallas, TX 75313

Periodic Partial Withdrawal/Partial Withdrawal Request 

 

Use this form to make a Partial Withdrawal or set up or modify an automated Periodic Partial Withdrawal Arrangement. To make a partial withdrawal from a Tax-Sheltered Annuity, please contact a Customer Service Representative at (800) 598-2019.

Fax number: (800) 278-4117

Download

 

Mailing address:
New York Life Insurance Company
Dallas Service Center
P.O. Box 130539
Dallas, TX 75313

Periodic Partial Withdrawal/Partial Withdrawal Request for Tax Sheltered Annuities

Fax number: (800) 278-4117

Download

 

Mailing address:
New York Life Insurance Company
Dallas Service Center
P.O. Box 130539
Dallas, TX 75313

Name Change Request Form

 

Use this form to process a change of Name on your policy.

Fax number: (800) 278-4117

Download

 

Mailing address:
New York Life Insurance Company
Dallas Service Center
P.O. Box 130539
Dallas, TX 75313

Direct Deposit Form

Fax number: (800) 278-4117

Download

 

Mailing address:
New York Life Insurance Company
Dallas Service Center
P.O. Box 130539
Dallas, TX 75313

Change of Beneficiary Form

 

Use this form to change the beneficiary on your policy. Do not use this form if your policy is a family plan or if it has rider insureds.

Fax number: (800) 278-4117

Download

 

Mailing address:
New York Life Insurance Company
Dallas Service Center
P.O. Box 130539
Dallas, TX 75313

Statement of Trust Form

 

Use this form to change the ownership of your policy to a Trust.

Fax number: (800) 278-4117

Download

 

Mailing address:
New York Life Insurance Company
Dallas Service Center
P.O. Box 130539
Dallas, TX 75313

Transfer of Ownership/Designation of Successor Owner

 

Use this form to request a transfer of ownership and/or designate a successor owner.

Fax number: (800) 278-4117

Download

 

Mailing address:
New York Life Insurance Company
Dallas Service Center
P.O. Box 130539
Dallas, TX 75313

My Payment Preferences Form

 

Use this form to set up a payment arrangement in which premiums are paid monthly by automatically deducting the money directly from your checking account.

Fax number: (800) 278-4117

Download

 

Mailing address:
New York Life Insurance Company
Dallas Service Center
P.O. Box 130539
Dallas, TX 75313

Telephone Authorization Form

 

Use this form to initiate telephone authorization to access information and/or process transactions over the telephone.

Fax number: (800) 278-4117

Download

 

Mailing address:
New York Life Insurance Company
Dallas Service Center
P.O. Box 130539
Dallas, TX 75313

Connect with a financial professional

We're here to help customize a plan that works best for you.

Go