Life Insurance and Annuities Surrender Request Form
This file contains details and instructions for the Surrender Request Form for life insurance and annuities. It provides essential information needed to properly fill out the form. Users can use this file to apply for a cash surrender value on their insurance policies.
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How do I fill this out?
To fill out this form, start by entering the insured's name and policy number. Next, provide the policyowner's name and any new address if applicable. Finally, review the provided instructions for signing and submitting the form.

How to fill out the Life Insurance and Annuities Surrender Request Form?
1
Enter the insured's name and policy number.
2
Complete the policyowner's name and new address if it has changed.
3
Indicate your election for tax withholding.
4
Sign and date the application.
5
Submit the form according to the submission instructions.
Who needs the Life Insurance and Annuities Surrender Request Form?
1
Policyholders looking to surrender their life insurance policies.
2
Individuals seeking to access the cash value of their annuities.
3
Beneficiaries who need to finalize benefits under a policy.
4
Financial advisors assisting clients in their policy management.
5
Tax professionals advising clients on distribution implications.
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What are the instructions for submitting this form?
To submit this form, you may email it to the designated address for your insurance provider. Alternatively, it can be faxed to the fax numbers provided on the form. If you prefer to send a physical copy, mail it to the home office address listed in your policy documentation; ensure it's sent with sufficient time for processing.
What are the important dates for this form in 2024 and 2025?
Important dates for the Surrender Request Form in 2024 include key IRS deadlines for tax withholding decisions. Keep an eye on submission deadlines for insurance company processing in 2025. Ensure timely submissions to avoid lapses in policy coverage or tax liabilities.

What is the purpose of this form?
The purpose of this form is to allow policyholders to formally request the surrender of life insurance and annuity policies. It serves as an official application for the cash surrender value, facilitating a critical financial transaction. By submitting this form, policyowners ensure they understand the implications of surrendering their policies.

Tell me about this form and its components and fields line-by-line.

- 1. Insured's Name: The name of the individual insured by the policy.
- 2. Policy Number: The unique number assigned to the insurance policy.
- 3. Policyowner's Name: The name of the person who owns the insurance policy.
- 4. New Address: Policyowner's new address if it has changed.
- 5. Signature: Signature of the policy owner to verify the request.
- 6. Date: The date when the application was signed.
What happens if I fail to submit this form?
If you fail to submit this form, your request to access the cash surrender value will not be processed. This means you will continue holding your current policy without changes. Additionally, failure to address tax withholding options may lead to unexpected tax liabilities when distributions occur.
- Unprocessed Request: Your cash surrender value request will remain unfulfilled, prolonging your access to funds.
- Policy Status: Your policy will remain active, and you may miss opportunities for termination benefits.
- Tax Implications: Without proper submission, tax withholding may default to standard amounts.
How do I know when to use this form?

- 1. Cash Surrender: To formally request the cash surrender value of your policy.
- 2. Policy Termination: When you decide to terminate your life insurance policy.
- 3. Withdrawal from Annuity: To withdraw funds from an annuity account.
- 4. Beneficiary Claims: For beneficiaries initiating claims under the policy.
- 5. Addressing Tax Withholding: To elect withholding options for distributions from the policy.
Frequently Asked Questions
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You can download the edited PDF after making your changes.
Is there a specific format I need to use when filling out the form?
Follow the instructions provided within the form to ensure all required fields are completed correctly.
What should I do if I have questions while filling out the form?
Refer to the instructions section or consult a financial advisor for assistance.
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How do I submit the form once it's completed?
Follow the submission instructions provided in the form for email, fax, or physical submission.
What if I need to make changes after I've submitted the form?
You may need to contact the company directly to discuss changes to your submitted form.
Will I receive confirmation of my submission?
Most companies will send a confirmation once your request has been processed.
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