Service Forms

File Name
Updated
Advisor Authorization Agreement - VA122 06/26/2020
Advisor Fee Instructions - VA151 07/24/2020
Agent Enrollment Request Form - VA 128 06/26/2020
Annuitization - Settlement Request Qualified or Non-Qualified Form - VA 120 06/26/2020
Annuity Claimant Statement Form - VA 114 06/26/2020
Annuity Claimant Statement Form for Lump Sum - VA 114LS 06/26/2020
Annuity Claimant Statement Form for Supplemental Contracts - VA 114SC 06/26/2020
Annuity Contract Change Request Form - VA 109 09/11/2020
Authorization to Transfer Funds and Replacement for AK, AL, AZ, CO, CT, HI, IA, KY, LA, MD, ME, MO, MS, NC, NE, NH, NJ, NM, OH, OR, SC, SD, TX, UT, VT, WI, WV - VA 121 06/26/2020
Authorization to Transfer Funds and Replacement for AR - VA 121 06/26/2020
Authorization to Transfer Funds and Replacement for CA - VA 121 06/26/2020
Authorization to Transfer Funds and Replacement for DC, ND - VA 121 06/26/2020
Authorization to Transfer Funds and Replacement for DE - VA 121 06/26/2020
Authorization to Transfer Funds and Replacement for FL - VA 121 06/26/2020
Authorization to Transfer Funds and Replacement for GA - VA 121 06/26/2020
Authorization to Transfer Funds and Replacement for ID, IL, TN - VA 121 06/26/2020
Authorization to Transfer Funds and Replacement for IN - VA 121 06/26/2020
Authorization to Transfer Funds and Replacement for KS - VA 121 06/26/2020
Authorization to Transfer Funds and Replacement for MA - VA 121 06/26/2020
Authorization to Transfer Funds and Replacement for MI - VA 121 06/26/2020
Authorization to Transfer Funds and Replacement for MN - VA 121 06/26/2020
Authorization to Transfer Funds and Replacement for MT - VA 121 06/26/2020
Authorization to Transfer Funds and Replacement for NV - VA 121 06/26/2020
Authorization to Transfer Funds and Replacement for OK - VA 121 06/26/2020
Authorization to Transfer Funds and Replacement for PA - VA 121 06/26/2020
Authorization to Transfer Funds and Replacement for RI - VA 121 06/26/2020
Authorization to Transfer Funds and Replacement for VA - VA 121 06/26/2020
Authorization to Transfer Funds and Replacement for WA - VA 121 06/26/2020
Authorization to Transfer Funds and Replacement for WY - VA 121 06/26/2020
Change Beneficiary Form - VA 108 06/26/2020
Collateral Assignment Form VA 106 06/26/2020
Contribution Form - VA 113 07/24/2020
Due Diligence Supplement - VA 123 06/26/2020
EFT Request Form - VA 110 04/27/2018
Financial Adviser and Broker Dealer Change Request Form - FA CHG 06/26/2020
Interest Sweep Request Form - VA 117 06/26/2020
Investment Instructions - VA130 09/25/2020
ORP Restriction Form - VA ORP 06/26/2020
Periodic Payment Enrollment Form (Non-Qualified) - VA126 - 72Q 06/26/2020
Periodic Payment Enrollment Form (Qualified) - VA126 - 72T 06/26/2020
Required Minimum Distribution Form for Beneficiaries - JNLRMDBEN 06/26/2020
Required Minimum Distribution Form for Owners - RMDOWN 06/26/2020
Suitability Form - VA 125 02/01/2018
Systematic Partial Withdrawal (Qualified) - VA 102 SYSQ 07/24/2020
Systematic Partial Withdrawal Form (Non-Qualified) – VA 102 SYSNQ 06/26/2020
TSA Hardship Withdrawal Request - VA 107 06/26/2020
TSA Loan Request Form - VA 105 06/26/2020
Third Party Payee Request Form - VA 112 06/26/2020
Transfer and Allocation Form - VA 118 06/26/2020
Advisor Authorization Agreement 09/01/2019
Advisor Fee Instructions - NW 09/01/2019
Beneficiary Change Form 09/07/2018
Certification of Trust 09/07/2018
Owner Change Request 09/07/2018
Producer Information Form 09/07/2018
SPIA Only - Liquidity Withdrawal Request 09/07/2018
SPIA Only - Payee Administration Form 09/07/2018

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