Service Forms

File Name
Updated
5 Year Delayed Income Surrender Request 07/01/2022
5 Year Delayed Income Surrender Request 07/01/2022
Account Change Request 07/01/2022
Acord 1035 Exchange Rollover Transfer Form Addendum 07/01/2022
Acord 1035 Exchange Rollover Transfer Form Addendum 07/01/2022
Acord 1035 Exchange Rollover Transfer Form Addendum 07/01/2022
Acord 1035 Exchange Rollover Transfer Form Addendum Beneficial Owner 07/01/2022
Additional Beneficiaries Form 07/01/2022
Certification of Trust 07/01/2022
Certification of Trust 07/01/2022
Contract Owner Withdrawal Form 07/01/2022
Contract Owner Withdrawal Form 07/01/2022
Custodial Owner and Account Change Form 07/01/2022
Custodial Owner and Account Change Form 07/01/2022
Fund Transfer and Allocation Request 07/01/2022
Fund Transfer and Allocation Request 07/01/2022
Internal Transfer Disclosure Form 07/01/2022
Internal Transfer Disclosure Form 07/01/2022
Lifetime Withdrawal Form 07/01/2022
Non-Lifetime Withdrawal Form 07/01/2022
Non-Lifetime Withdrawal Form 07/01/2022
Release of Collateral Assignment 07/01/2022
Release of Collateral Assignment 07/01/2022
Restriction of Beneficiary Options 07/01/2022
Investment Instructions - Monument Advisor Select 04/29/2022
Investment Instructions -Monument Advisor 04/29/2022
Custom Choice Request 04/29/2022
Nationwide Insurance Only Producer Non-Solicitation Form 04/29/2022
Transfer of Assets and Replacement for ID, IL, TN - APO-1868-17Y-NA 02/25/2022
Annuity Beneficiary Claim Form 01/14/2022
Annuity Beneficiary Claim Form 01/14/2022
Annuity Beneficiary Claim Form 01/14/2022
Payout Beneficiary Claim Form 01/14/2022
Payout Beneficiary Claim Form 01/14/2022
Beneficiary Change Request 11/19/2021
Beneficiary Change Request 11/19/2021
Immediate Annuity Owner Change Request 11/19/2021
Required Minimum Distribution (RMD) Request Form 11/19/2021
Advisor Authorization Agreement 11/01/2021
Beneficial Owner Life Expectancy Distribution Administration Form 11/01/2021
Beneficiary Change Request 11/01/2021
Required Minimum Distribution (RMD) Request Form 11/01/2021
Restriction of Beneficiary Options 11/01/2021
Transfer of Assets 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 - APO-1868-17Y-NA 11/01/2021
Transfer of Assets and Replacement for AR - APO-1868-17Y-NA 11/01/2021
Transfer of Assets and Replacement for CA - APO-1868-17Y-NA 11/01/2021
Transfer of Assets and Replacement for DE - APO-1868-17Y-NA 11/01/2021
Transfer of Assets and Replacement for FL - APO-1868-17Y-NA 11/01/2021
Transfer of Assets and Replacement for GA - APO-1868-17Y-NA 11/01/2021
Transfer of Assets and Replacement for IN - APO-1868-17Y-NA 11/01/2021
Transfer of Assets and Replacement for KS - APO-1868-17Y-NA 11/01/2021
Transfer of Assets and Replacement for MA - APO-1868-17Y-NA 11/01/2021
Transfer of Assets and Replacement for MI - APO-1868-17Y-NA 11/01/2021
Transfer of Assets and Replacement for MN - APO-1868-17Y-NA 11/01/2021
Transfer of Assets and Replacement for MT - APO-1868-17Y-NA 11/01/2021
Transfer of Assets and Replacement for NV - APO-1868-17Y-NA 11/01/2021
Transfer of Assets and Replacement for OK - APO-1868-17Y-NA 11/01/2021
Transfer of Assets and Replacement for PA - APO-1868-17Y-NA 11/01/2021
Transfer of Assets and Replacement for RI - APO-1868-17Y-NA 11/01/2021
Transfer of Assets and Replacement for VA - APO-1868-17Y-NA 11/01/2021
Transfer of Assets and Replacement for WA - APO-1868-17Y-NA 11/01/2021
Transfer of Assets and Replacement for WY - APO-1868-17Y-NA 11/01/2021
Account Change Request 11/01/2021
Advisor Authorization Agreement 11/01/2021
Annuity Beneficiary Claim Form 11/01/2021
Beneficial Owner Life Expectancy Distribution Administration Form 11/01/2021
Beneficiary Change Request 11/01/2021
Deferred Annuitization Election Form 11/01/2021
Lifetime Withdrawal Form 11/01/2021
Required Minimum Distribution (RMD) Request Form 11/01/2021
Restriction of Beneficiary Options 11/01/2021
Restriction of Beneficiary Options 11/01/2021
Transfer of Assets 11/01/2021
Transfer of Assets to Nationwide 08/08/2021
Designation of Restricted Beneficiary for Immediate Annuity 06/11/2021
Systematic Partial Withdrawal Form (Non-Qualified) – VA 102 SYSNQ 05/28/2021
Annuity Contract Change Request Form - VA 109 09/11/2020
Advisor Fee Instructions - VA151 07/24/2020
Contribution Form - VA 113 07/24/2020
Systematic Partial Withdrawal (Qualified) - VA 102 SYSQ 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
Collateral Assignment Form VA 106 06/26/2020
Due Diligence Supplement - VA 123 06/26/2020
Financial Adviser and Broker Dealer Change Request Form - FA CHG 06/26/2020
Interest Sweep Request Form - VA 117 06/26/2020
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
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 Fee Instructions - NW 09/01/2019
Additional Beneficiaries Form 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
EFT Request Form - VA 110 04/27/2018

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