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Forms

 

Category:
Form Name Description View Download
Application for Settlement Option Benefit

Use this form in lieu of all benefits, otherwise payable under your contract.  Once payments begin, this option is final.

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Form A-4P, Request for Arizona Income Tax Withholding

Request for Arizona Income Tax Withholding.

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Change of Beneficiary

This form is used to Change the Beneficiary Designations - Only Owners may make this change.

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Election of Withholding

Use this form when making a change to your current disbursements.

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Electronic Funds Transfer (EFT)

Use this form for systematic withdrawal payments, authorizing Eagle Life to send payments directly into your checking account.

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Information Update Request

Use this form to update a name change, address change or password addition.

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Lifetime Income Benefit Rider Termination Form

This form is required for termination of the Lifetime Income Benefit Rider.  Once terminated, the rider cannot be restarted at any time.  This election is irrevocable.

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Ownership Change

Policy Owner(s) use this form to request a Change of Ownership

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Partial Withdrawal Request

Use this form to request a withdrawal from you contract.

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Pre-Authorized Payments (PAC)

Use this form to authorize monthly deposits into your annuity contract from your checking account.  A voided check is required.  (Starter checks and deposit slips will be rejected.)

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Required Minimum Distribution Withdrawal Request

Use this form to take your Required Minimum Distributions.

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Roth Conversion

This form is required for either a Full Roth Conversion or Partial Roth Conversion of your IRA contract.

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Systematic Withdrawal Request

This form is used to request systematic withdrawals either monthly, quarterly, semi-annually or annually after the first contract year.

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Transfer of Values Authorization Form

Use this form to reallocate your interest crediting strategies once per Contract Year

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W-9

Required for each contract owner.

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Form MI W-4P

Withholding Certificate for Michigan Annuity Payments.

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Terminal Condition Verification

This form is required along with a Partial Withdrawal form in order to exercise the Terminal Illness option outlined in your contract.

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Qualified Care Facility Verification Form View form Download form
Certification of Trust Agreement View form Download form