Service Forms
Need to change your beneficiary? File a claim? Request a withdrawal? All of the forms you may need are just a few questions away.
First, we need to find out more about your product.
What type of contract or policy do you have?
Annuity
Life Insurance
Accident & Health
Disability
Long Term Care
Accidental Death
What is the name of the issuing company listed on your contract or policy?
Athene Annuity and Life Company
(formerly Aviva Life and Annuity Company, Athene Life Insurance Company of New York)
Athene Annuity & Life Assurance Company of New York
(formerly Presidential Life Insurance Company)
Athene Annuity & Life Assurance Company
(formerly Liberty Life Insurance Company, Investors Insurance Corporation, Magnolia Life, Southern Life, State National, Kentucky Central, RBC Insurance, Business Mens Assurance Company)
What type of life policy do you have?
Term
--> Term, Traditional and Universal
Traditional
--> Whole
Universal
--> Variable
What was the original issuing company of your policy?
Liberty Life, RBC Insurance or Business Mens Assurance Company
Liberty Life (Mortgage Term Life)
What was the original issuing company of your policy?
Magnolia Life, Southern Life, State National or Kentucky Central
Liberty Life, RBC Insurance or Business Mens Assurance Company
What is the name of the issuing company listed on your contract or policy?
Athene Annuity and Life Company
(formerly Aviva Life and Annuity Company, Athene Life Insurance Company of New York)
Athene Annuity & Life Assurance Company of New York
(formerly Presidential Life Insurance Company)
Athene Annuity & Life Assurance Company
(formerly Liberty Life Insurance Company, Investors Insurance Corporation, Integon or Liberty Life Insurance Company, RBC Insurance, Business Mens Assurance Company)
What was the original issuing company of your policy?
Quincy
Other
Does your contract number begin with NY1 or 66?
Does your contract begin with:
VA01 or 05?
MA?
None of the above
What was the original issuing company name?
Investors Insurance Corporation
Integon, Liberty Life Insurance Company, RBC Insurance or Business Mens Assurance Company
What is the name of the issuing company listed on your contract or policy?
Athene Annuity and Life Company
(formerly Aviva Life and Annuity Company, Athene Life Insurance Company of New York)
Athene Annuity & Life Assurance Company
(formerly Liberty Life Insurance Company, Investors Insurance Corporation, Integon or Liberty Life Insurance Company, RBC Insurance, Business Mens Assurance Company)
What is the name of the issuing company listed on your contract or policy?
Athene Annuity and Life Company
(formerly Aviva Life and Annuity Company, Athene Life Insurance Company of New York)
Athene Annuity & Life Assurance Company
(formerly Liberty Life Insurance Company)
Why the questions?
Because we've grown through the acquisition of multiple companies, with separate support teams.
Can't find the form you're looking for?
Call 888-ANNUITY (888-266-8489) and we'll be happy to help you.
Your results.
Call 855-615-2276 to speak to an Alliance-One customer service representative.
Your results.
Call 877-462-8992 to speak to an Alliance-One customer service representative.
Your results.
Administrative Forms
- Address Change Request
- Name Change Request
- Electronic Funds Transfer Fund
- Authorization to Release Information
- Pension Plan Verification
Policy Change Forms
- Beneficiary Change Request
- Additional Beneficiaries Designation- Supplement to Beneficiary Change
- Trust Verification Form
- Request for Service Form
- Change of Ownership Form
- Income Benefit Rider Election and Service Request Form - TargetPay and TargetPay Plus
Withdrawal Request Forms
- Required Minimum Distribution (RMD) Request
- Systematic Withdrawal Form
- Withdrawal Request
- Withdrawal Request - Tax Sheltered Annuity (TSA)
- Qualified Charitable Distribution (QCD)
- Income Rider Withdrawal Request for BPA Income
- Income Rider Withdrawal Request for Fixed Products
- Income Rider Withdrawal Request for Indexed Products
- Income Rider Withdrawal Request for LifeTime Solutions Annuity
- Terminal Illness Withdrawal Packet
- Confinement Withdrawal Packet
Tax Forms
Buyer's Guides
- Annuity Buyer's Guide
- Annuity Buyer's Guide - KY
- Annuity Buyer's Guide - WI
Claim Forms
- Annuity Claim Form Statement of Beneficiary - for beneficiaries of contracts in a payout/settlement status
- Life Claim Form - for beneficiaries of American Investors Life policies
- Individual Beneficiary Qualified Claims Form Kit
- Entity Beneficiary Claims Form Kit
- Individual Beneficiary Non-Qualified Claims Form Kit
- Trust Beneficiary Claims Form Kit
- Estate Beneficiary Claims Form Kit
Your results.
Call 888-266-8489 to speak to a customer service representative.
Your results.
Administrative Forms
- Electronic Funds Transfer (EFT) Authorization
- Address Change Form
- Name Change Form
- Power of Attorney Affidavit
- Authorization to Release Policy Information
- Verification of Trust
Policy Change Form
- Beneficiary Change Form
- Ownership Change Form
- Collateral Assignment of Life Insurance or Non-Qualified Annuity Form
- Transfer of Collateral Assignment
- Collateral Assignment Release
- Request for Policy Change
- Request for Policy Change Flexible Premium Universal Life
- Request to Convert – Term Policy to Whole Life
- Request to Change to Extended Term or Reduced Paid Up
Withdrawal Forms
- Request for Full/Partial Surrender - Life Insurance
- Life Loan Agreement
- Request for Distribution of Life Insurance Maturity Proceeds
- Athene Annuity & Life Assurance Company of New York Appendix 10C (Alternate 1)
- Athene Annuity & Life Assurance Company of New York Appendix 11 (Alternate 1)
Your results.
Call 800-866-9933 to speak to a Protective Life Insurance customer service representative.
Your results.
Call 800-866-9933 to speak to a Protective Life Insurance customer service representative.
Your results.
Administrative Forms
- Authorize an Electronic Funds Transfer EFT
- Authorize to release policy information
- Name Change Form
- Address Change Form
- Electronic Funds Deposit Authorization
- Request a duplicate policy certificate
- Affidavit of Power of Attorney
Policy Change Forms
- Change of Annuitant Form
- Beneficiary Change Form
- Owner Change Form
- Trust Verification Form
- Assign my policy and I live in Louisiana
- Collateral Assignment Release Form
- Collateral Assignment Form
- Transfer of Collateral Assignment Form
- Change of Payee
- Co-Owner Change Form
- Pension Plan Verification Form
- Company, Partnership or LLC Verification Form
- Divorce Affidavit Form
Withdrawal Request Forms
- Annuitize my contract
- Authorize automatic withdrawals from my annuity contract
- Make a partial withdrawal from my annuity contract
- Surrender my annuity contract
- Request a required minimum distribution
- Make a partial withdrawal from my TSA/403b contract
- Surrender my TSA/403b contract
- Substantially Equal Periodic Payments under 72q & 72t
Transfer/Rollover Forms
- Convert my existing traditional IRA to a Roth IRA
- Transfer funds from Employee Retirement Plan
- Traditional-IRA to Roth-IRA Conversion
- 1035 Exchange/Absolute Assignment
Your results.
Call 800-866-9933 to speak to a Protective Life Insurance customer service representative.
Your results.
Administrative Forms
- Authorize to Release Policy Information
- Name Change Form
- Address Change Form
- Electronic Funds Deposit Authorization
- Affidavit of Power of Attorney
Policy Change Forms
- Change of Annuitant Form
- Beneficiary Change Form
- Owner Change Form
- Trust Verification Form
- Collateral Assignment Release Form
- Collateral Assignment Form
- Transfer of Collateral Assignment Form
- Change of Payee
- Co-Owner Change Form
- Pension Plan Verification Form
- Company, Partnership or LLC Verification Form
- Divorce Affidavit Form
Withdrawal Request Forms
- Withdrawal and Surrender Request – Annuity Contracts Only
- Withdrawal, Surrender and RMD -Pension Plan (does not include 403(b)/TSA)
- Systematic Withdrawal Request
- Required Minimum Distribution (RMD) Request
- Substantially Equal Periodic Payments under 72q and 72t
- TSA Withdrawal and Surrender Request
- TSA Loan Request
- Annuitize My Contract
- IRA Qualified Charitable Distribution Request
- Withholding Election Change Form
Transfer/Rollover Forms
- Change your existing 403(b)/TSA to a Traditional IRA
- Change your existing Traditional IRA to a SEP-IRA
- Change your existing Pension, Money Purchase, or Profit Sharing Plan to a Traditional IRA
- Change your existing SEP-IRA to a Traditional IRA
- Change your existing 401(k) to a Traditional IRA
- Convert your existing Traditional IRA to a Roth IRA
Your results.
Call 800-866-9933 to speak to a Protective Life Insurance customer service representative.
Your results.
Call 800-866-9933 to speak to a Protective Life Insurance customer service representative.
Your results.
Administrative Forms
- Address Change Form
- Name Change Form
- Authorize an Electronic Funds Transfer (EFT)
- Affidavit of Attorney-in-Fact
- Authorization to Release Policy Information
- Verification of Trust
Policy Change and Disbursement Forms
- Variable Universal Life Service Request Form
- Beneficiary Change Form
- Ownership Change Form
- Collateral Assignment of Life Insurance or Non-Qualified Annuity Form
- Transfer of Collateral Assignment
- Collateral Assignment Release
Your results.
Administrative Forms
- Authorize to release policy information
- Name Change Form
- Address Change Form
- Electronic Funds Deposit Authorization
- Affidavit of Power of Attorney
Policy Change Forms
- Clarity Variable Annuity Service Request Form
- Clarity 2+2 Variable Annuity Service request Form
- Change of Payee Form
- Change of Annuitant Form
- Beneficiary Change Form
- Owner Change Form
- Co-Owner Change Form
- Trust Verification Form
- Collateral Assignment Release Form
- Collateral Assignment Form
- Transfer of Collateral Assignment Form
- Pension Plan Verification Form
- Company, Partnership or LLC Verification Form
- Divorce Affidavit Form
Withdrawal Request Forms
- Variable Annuity Disbursement Request Form
- Annuitize my contract
- Make an IRA Qualified Charitable Distribution
Your results.
Administrative Forms
- Authorize to release policy information
- Name Change Form
- Address Change Form
- Electronic Funds Deposit Authorization
Policy Change Forms
- Change of Annuitant Form
- Beneficiary Change Form
- Owner Change Form
- Co-Owner Change Form
- Affidavit of Power of Attorney
- Change of Payee Form
- Trust Verification Form
- Pension Plan Verification Form
- Company, Partnership or LLC Verification Form
- Collateral Assignment Release Form
- Collateral Assignment Form
- Transfer of Collateral Assignment Form
- Divorce Affidavit Form
Withdrawal Request Forms
- Annuitize my contract
- Make an IRA Qualified Charitable Distribution
- Withdrawal and Surrender Request- Annuity Contracts Only
- Withdrawal, Surrender and RMD - Pension Plan (does not include 403(b)/TSA)
- Request a required minimum distribution
- Substantially Equal Periodic Payments under 72q & 72t
- Request withdrawal under Terminal Illness/Confinement Waiver
- Benefit 10 – Request withdrawal under Terminal Illness/Confinement
- Request to Begin, Suspend or Restart Income Rider Payments; Request to Terminate Income Rider
- Benefit 10 – Request to Begin, Suspend or Restart Income Rider Payments; Request to Terminate Income Rider
Transfer/Rollover Forms
- Traditional-IRA to Roth-IRA Conversion
- Request to Rollover
- Request to Transfer Traditional IRA to SEP-IRA
- Request to Transfer SEP-IRA to Traditional IRA
- Request to Transfer
Your results.
Administrative Forms
- Authorization to Release Policy Information
- Electronic Funds Deposit Authorization
- Affidavit of Power of Attorney
- Name Change Form
- Address Change Form
Policy Change Forms
- Collateral Assignment
- Collateral Assignment Release Form
- Transfer of Collateral Release Form
- Change of Payee
- Change of Annuitant Form
- Beneficiary Change Form
- Owner Change Form
- Co-Owner Change Form
- Trust Verification Form
- Pension Plan Verification Form
- Company, Partnership or LLC Verification Form
- Divorce Affidavit Form
Withdrawal Request Forms
- Withdrawal and Surrender Request – Annuity Contracts Only
- Withdrawal, Surrender and RMD -Pension Plan (does not include 403(b)/TSA)
- Systematic Withdrawal Request
- Substantially Equal Periodic Payments under 72q and 72t
- TSA Withdrawal and Surrender Request
- TSA Loan Request
- Required Minimum Distribution (RMD) Form
- Annuitize My Contract
- IRA Qualified Charitable Distribution Request
- Withholding Election Change Form
- TSA Loan Repayment Distribution Form
Transfer/Rollover Forms
- Change your existing 403(b)/TSA to a Traditional IRA
- Change your existing Traditional IRA to a SEP-IRA
- Change your existing Pension, Money Purchase, or Profit Sharing Plan to a Traditional IRA
- Change your existing SEP-IRA to a Traditional IRA
- Change your existing 401(k) to a Traditional IRA
- Convert your existing Traditional IRA to a Roth IRA
Your results.
Administrative Forms
- Address Change Form
- Name Change Form
- Power of Attorney Affidavit
- Authorization to Release Policy Information
- Trust Verification Form
Policy Change Forms
- Beneficiary Change Form
- Ownership Change Form
- Collateral Assignment of Life Insurance or Non-Qualified Annuity Form
- Transfer of Collateral Assignment
- Collateral Assignment Release
- Request for Policy Change
- Policy Change Flexible Premium Universal Life
- Request to Convert – Term Policy to Whole Life
- Request to Change to Extended Term or Reduced Paid Up
Withdrawal Forms
- Request for Full/Partial Surrender - Life Insurance
- Life Loan Agreement
- Request for Distribution of Life Insurance Maturity Proceeds
Your results.
Administrative Forms
- Electronic Funds Transfer (EFT) Authorization
- Electronic Funds Deposit Authorization
- Name Change Form
- Address Change Form
- Authorization to Release Information
- Affidavit of Power of Attorney
Policy Change Forms
- Change of Payee
- Beneficiary Change Form
- Change of Ownership Form
- Co-Owner Change Form
- Change of Annuitant Form
- Collateral Assignment
- Collateral Assignment Release Form
- Transfer of Collateral Assignment
- Trust Verification Form
- Pension Plan Varification Form
- Company, Partnership or LLC Verification Form
- Divorce Affidavit Form
Withdrawal Request Forms
- Required Minimum Distribution Package
- Annuity Substantially Equal Periodic Payments Under I.R.C. Sections 72(Q) and 72(T)
- Partial Withdrawal / Full Surrender Request
- Annuity Systematic Withdrawal Form
- Make an IRA Qualified Charitable Distribution
- Settlement Option Election Form
- Withdrawal and Surrender Request - Corporate Pension
- Athene Annuity & Life Assurance Company of New York Appendix 10C (Alternate 1)
- Athene Annuity & Life Assurance Company of New York Appendix 11 (Alternate 1)
- Request Partial Withdrawal or Full Surrender under Confinement Waiver or Terminal Illness Waiver
- Benefit 10- Request for Withdrawal under Terminal Illness or Confinement Provision
Transfer/Rollover Forms
- Internal Traditional IRA to Roth IRA Conversion
- Request to Transfer SEP-IRA to Traditional IRA
- Request to Transfer Traditional IRA to SEP-IRA
- Request to Transfer Qualified Plan to Qualified Plan
- Request to Rollover 403(b) TSA to Traditional IRA
Tax Forms
Your results.
Call 800-366-5463 to speak to a LifeCare Assurance Company customer service representative.
Claim Forms
For claim forms, call 800-800-9882 to speak with a customer service representative.
Contact Information
Mailing Address:
P.O. Box 1555
Des Moines, IA 50306-1555
Claim Forms
For claim forms, call 800-800-9882 to speak with a customer service representative.
Contact Information
Mailing Address:
P.O. Box 1555
Des Moines, IA 50306-1555
Contact Information
Mailing Address:
P.O. Box 1555
Des Moines, IA 50306-1555
Claim Forms
For claim forms, call 800-926-7599 to speak with a customer service representative.
Contact Information
Mailing Address:
PO Box 64269
St. Paul, MN 55164-0269
Claim Forms
For claim forms, call 800-234-5514 to speak with a customer service representative.
Contact Information
Mailing Address:
PO Box 64294
St. Paul, MN 55164-0294
Claim Forms
For claim forms, call 800-234-5514 to speak with a customer service representative.
Contact Information
Mailing Address:
PO Box 64294
St. Paul, MN 55164-0294
Claim Forms
For claim forms, call 800-423-9398 to speak with a customer service representative.
Contact Information
Mailing Address:
PO Box 64296
St. Paul, MN 55164-0296
Claim Forms
For claim forms, call 800-423-9398 to speak with a customer service representative.
Contact Information
Mailing Address:
PO Box 64296
St. Paul, MN 55164-0296
Claim Forms
For claim forms, call 866-690-1992 to speak with a customer service representative.
Contact Information
Mailing Address:
PO Box 725449
Atlanta, GA 31139
Contact Information
Mailing Address:
PO Box 64285
St. Paul, MN 55164-0285
Claim Forms
For claim forms, call 866-626-1161 to speak with a customer service representative.
Contact Information
Mailing Address:
PO Box 64285
St. Paul, MN 55164-0285
Claim Forms
For claim forms, call 800-926-7599 to speak with a customer service representative.
Contact Information
Mailing Address:
PO Box 64279
St. Paul, MN 55164-0279
© Athene. All Rights Reserved.
Annuities contain features, exclusions, limitations and availability that may vary by state and/or sales distributor. For a full explanation of an annuity, please refer to the Certificate of Disclosure or Prospectus (as applicable) and contact your financial professional or the company for costs and complete details. This material is a general description intended for general public use.
Annuity contracts and group annuity contracts are issued by Athene Annuity and Life Company (61689), West Des Moines, IA, in all states (except New York), and in D.C. and P.R. Annuity contracts are issued by Athene Annuity & Life Assurance Company of New York (68039), Pearl River, NY, in New York. Group annuity contracts for New York residents and New York contract holders are issued in New York by Athene Annuity & Life Assurance Company of New York, Pearl River, NY. Payment obligations and guarantees are subject to the financial strength and claims-paying ability of the issuing insurance company. Insurance products may not be available in all states. These companies are not undertaking to provide investment advice for any individual or in any individual situation, and therefore nothing in this should be read as investment advice. This material should not be interpreted as a recommendation by Athene Annuity and Life Company, Athene Annuity & Life Assurance Company of New York, or Athene Securities, LLC. Please reach out to your financial professional if you have any questions about insurance products and their features.
The term “financial professional” is not intended to imply engagement in an advisory business with compensation unrelated to sales. Financial professionals will be paid a commission on the sale of an annuity.
INVESTMENT AND INSURANCE PRODUCTS ARE: • NOT FDIC INSURED • NOT INSURED BY ANY FEDERAL GOVERNMENT AGENCY • NOT A DEPOSIT OR OTHER OBLIGATION OF, OR GUARANTEED BY, THE BANK OR ANY OF ITS AFFILIATES • SUBJECT TO INVESTMENT RISKS, INCLUDING POSSIBLE LOSS OF THE PRINCIPAL AMOUNT INVESTED
Reinsurance contracts are entered into with Athene Annuity and Life Company (61689), West Des Moines, IA; Athene Annuity & Life Assurance Company (61492), Wilmington, Delaware; Athene Annuity & Life Assurance Company of New York (68039), Pearl River, NY; Athene Life Re Ltd., Hamilton, Bermuda; and Athene Annuity Re Ltd., Hamilton, Bermuda. Not all reinsurance products or structures offered are available in all jurisdictions. Reinsurers may not be licensed in all states. All transactions are subject to meeting a reinsurer’s underwriting requirements. Reinsurance products are not protected or guaranteed by state insurance guaranty associations or insolvency funds.
