Service Forms

File Name
Updated
Advisor Authorization Agreement - VA122 09/01/2019
Advisor Fee Instructions - VA151 02/01/2018
Agent Enrollment Request Form - VA 128 04/27/2018
Annuitization - Settlement Request Qualified or Non-Qualified Form - VA 120 04/27/2018
Annuity Claimant Statement Form - VA 114 04/27/2018
Annuity Claimant Statement Form for Lump Sum - VA 114LS 04/27/2018
Annuity Claimant Statement Form for Supplemental Contracts - VA 114SC 04/27/2018
Annuity Contract Change Request Form - VA 109 05/07/2018
Authorization to Transfer Funds and Replacement for AK, AL, AR, AZ, CO, CT, HI, IA, KY LA, MD, ME, MS, MT, NC, NE, NH, NM, NV, OH, OR, RI, SC, SD, TX, UT, VA, WV, WI - VA 121 05/07/2018
Authorization to Transfer Funds and Replacement for CA, DE, ID, IL - VA 121 05/07/2018
Authorization to Transfer Funds and Replacement for DC, GA, MI, ND - VA 121 05/07/2018
Authorization to Transfer Funds and Replacement for FL - VA 121 05/07/2018
Authorization to Transfer Funds and Replacement for IN - VA 121 05/07/2018
Authorization to Transfer Funds and Replacement for KS - VA 121 05/07/2018
Authorization to Transfer Funds and Replacement for MA - VA 121 05/07/2018
Authorization to Transfer Funds and Replacement for MN - VA 121 05/07/2018
Authorization to Transfer Funds and Replacement for MO - VA 121 05/07/2018
Authorization to Transfer Funds and Replacement for NJ - VA 121 05/07/2018
Authorization to Transfer Funds and Replacement for OK - VA 121 05/07/2018
Authorization to Transfer Funds and Replacement for PA - VA 121 05/07/2018
Authorization to Transfer Funds and Replacement for TN - VA 121 05/07/2018
Authorization to Transfer Funds and Replacement for VT - VA 121 05/07/2018
Authorization to Transfer Funds and Replacement for WA - VA 121 05/07/2018
Authorization to Transfer Funds and Replacement for WY - VA 121 05/07/2018
Change Beneficiary Form - VA 108 04/27/2018
Collateral Assignment Form VA 106 04/27/2018
Contribution Form - VA 113 04/27/2018
Due Diligence Supplement - VA 123 04/27/2018
EFT Request Form - VA 110 04/27/2018
Financial Adviser and Broker Dealer Change Request Form - FA CHG 04/27/2018
Interest Sweep Request Form - VA 117 04/27/2018
Investment Instructions - VA130 03/13/2020
ORP Restriction Form - VA ORP 04/27/2018
Periodic Payment Enrollment Form (Non-Qualified) - VA126 - 72Q 04/27/2018
Periodic Payment Enrollment Form (Qualified) - VA126 - 72T 04/27/2018
Required Minimum Distribution Form for Beneficiaries - JNLRMDBEN 04/27/2018
Required Minimum Distribution Form for Owners - RMDOWN 04/27/2018
Suitability Form - Monument Advisor - VA 125 04/27/2018
Systematic Partial Withdrawal (Qualified) - VA 102 SYSQ 04/27/2018
Systematic Partial Withdrawal Form (Non-Qualified) – VA 102 SYSNQ 04/27/2018
TSA Hardship Withdrawal Request - VA 107 04/27/2018
TSA Loan Request Form - VA 105 04/27/2018
Third Party Payee Request Form - VA 112 04/27/2018
Transfer and Allocation Form - VA 118 04/27/2018
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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