Service Forms

Form Description & Number Form Description Number
Beneficiary Forms
Beneficiary Designation IL-61-0002
Distribution Forms
Election of Annuitization IL-00-1943
Individual Retirement Account Required Minimum Distributions IL-77-31013
Partial Withdrawal / Policy Loan Request IL-77-0052
Request for Surrender IL-77-0053
Request for Systematic Payment Plan IL-00-1176
Systematic Withdrawal Request IL-00-1812
Miscellaneous Forms
Guarantee Rate Option Renewal IL-77-0001
Non-Financial Service Request IL-00-3185
Ownership Change Request IL-77-0034
Form Description & Number Form Description Number
Beneficiary Forms
Beneficiary Designation NI-61-0020
Distribution Forms
Election of Annuitization NI-00-1944
Individual Retirement Account Required Minimum Distributions NI-77-31008
Partial Withdrawal / Policy Loan Request NI-77-0049
Policy Benefit Disposition NI-DO-70
Request for Surrender NI-77-0050
Request for Systematic Payment Plan NI-00-2111
Systematic Withdrawal Request NI-00-1813
Miscellaneous Forms
Absolute Assignment NI-DO-598-LF
Guarantee Rate Option Renewal NI-77-0001
Name Successor Owner NI-2339-LF
Non-Financial Service Request NI-00-3186
Notification of Death of Owner NI-398-LF
Ownership Change Request NI-77-0039
Request for Policy Service NI-DO-43-LF
Form Description & Number Form Description Number
Beneficiary Forms
Annuity Service Request - Non-Financial Transactions - Beneficiary Designation FI-42-058
Distribution Forms
Annuity Service Request - Financial Transactions FI-42-057
Election of Annuity Income Option 1834
Individual Retirement Account Required Minimum Distributions 1141-IFS
Request for Premium/Dividend/Loan Policy Benefit Disposition DO-70
Systematic Withdrawal Request 703
Miscellaneous Forms
Absolute Assignment / Ownership Change DO-598
Authorization to Withdraw Funds from a Checking or Savings Account 1912-IFS
Long Term Care Confinement Certification 2841
Name Successor Owner 2339-0109
Notification of Death of Owner 398
Request for Policy Service DO-43

Updated 10.9.15

CF-60-0000-1512