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Service forms library: Variable Life Insurance

To download a Service Form on your policy, please click on the appropriate form name. Please mail your completed form to:

New York Life Insurance and Annuity Corporation
Variable Products Service Center
Madison Square Station
P.O. Box 922
New York, NY 10159

Note: You must have Adobe Acrobat Reader to view these files. If you do not have this, please visit the Adobe Website to install Adobe Acrobat Reader.

Automatic Asset Reallocation Form
Use this form to authorize reallocating the separate account values to a specific percentage that you select for each Investment Division on either a quarterly, semi-annual, or annual basis.

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.

Change of Beneficiary Form - Multiple Insureds
Use this form to change your beneficiary if your policy is a family plan or if it has rider insureds.

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

Change of Premium / Expense Allocation & Funds Transfer Form
Use this form to:
a) Change how future premiums are applied.
b) Select or Change how expense charges are deducted.
c) Transfer funds from one Investment Division and/or Fixed Account to another.

Check-O-Matic (C-O-M) Request 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.

Dollar Cost Averaging Form
Use this form to establish DCA on a policy and/or make a change to an existing DCA arrangement.

Interest Sweep Form
Use this form to elect the Interest Sweep option. This option provides for the interest earned on monies allocated to the Fixed Account to be transferred from the Fixed Account to any combination of Investment Divisions.

Loan Request Form
Use this form to request a Loan against your policy.

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

Partial Withdrawal Request Form
Use this form to request a Partial Withdrawal. Do not use this form for a Full Surrender.

IRS Form W-4P - Withholding Certificate for Pension or Annuity Payments
Use this form for all annuity contract death claims.

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

Instructions for the Requester of Form W-9
Instructions to complete the IRS Form W-9.

IRS Form W-8BEN - Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding
Use this form if the beneficiary for a death claim is a non U.S. citizen residing abroad.

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

Transfer of Ownership / Designation of Successor Owner Form
Use this form to request a transfer of ownership and/or designate a successor owner.

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

To obtain additional Service Forms or to request certain transactions on your policy, please contact a Customer Service Representative at (800) 598 - 2019.