Forms

Customer Service Forms

American Equity of New York is committed to provide superior customer service and provides our clients and representatives easy access to preview, download, or email the necessary forms for your annuity contract needs. We thank you for your business.

Form Name View Download Email
Application for Settlement Option Benefits
Beneficiary Claim Form
Beneficiary Claim Form - Deaths Occurring On or Before 12.31.19
Beneficiary Claim Form - Non-Qualified Account (i.e. other than IRAs)- Deaths Occurring On or After 01.01.20
Beneficiary Claim Form - Qualified Account (i.e. IRAs) - Death Occurring On or After 01.01.20
Certification of Trust Agreement
Election of Withholding
Electronic Funds Transfer (EFT)
Form IT-2104-P, New York Tax Withholding Form
Information Update Request
Nursing Care Verification
Ownership Change
Partial Withdrawal Request
Pre-Authorized Payments (PAC)
Qualified Charitable Distributions Form Instructions
Required Minimum Distribution Withdrawal Request
Roth Conversion
Systematic Withdrawal Request
Terminal Illness Verification
W9