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View: Life Insurance forms | Annuity forms | Long Term Care Insurance forms

Life Insurance forms

Address, name and third party changes
Submit address or name changes for yourself or other parties on your policy, or to add, change or delete a third party listed on your policy to receive billing notices (for use with Life Insurance policies only).

Certification of trustee powers 
Required to show signing authority for contracts owned by a Trust for Genworth Life and Annuity Insurance Company, Genworth Life Insurance Company and Genworth Life Insurance Company of New York. 

Declaration of attorney-in-fact (for use with Life Insurance and Annuities only)
Required to show signing authority for an Attorney-in-Fact acting under a Power of Attorney for the policy or contract owner. For use with Life Insurance and Annuities only.

Duplicate contract authorization
Request a duplicate copy of a lost or destroyed policy or contract.

Electronic funds transfer (EFT) - Premium Renewal
Request automatic withdrawals from your bank account to pay premiums on life or long term care insurance policies, or to update bank account information for policies already drafting premiums.

       Login to submit your electronic funds transfer online

Health information authorization
An authorization form allowing us to share your health history and related health information with a third party, whom you've designated.

Ownership and beneficiary designation request form (All states except NH, VT & WA)
Request owner or beneficiary changes on any life insurance policy.

Ownership and beneficiary designation request form (New Hampshire Residents Only)
Request owner or beneficiary changes on any life insurance policy.

Ownership and beneficiary designation request form (Vermont Residents Only)
Request owner or beneficiary changes on any life insurance policy.

Ownership and beneficiary designation request form (Washington Residents Only)
Request owner or beneficiary changes on any life insurance policy.

Surrender, loan or withdrawal authorization 

Used to request a loan or withdrawal on your life insurance policy. Also used to request a full surrender of a life insurance policy. For annuities, please use either the Fixed annuities withdrawal authorization form or the Variable annuities withdrawal authorization form. This form is used for Life Insurance Policies only.

Annuity forms

Address change form for Structured Settlements or Terminal Funding/Pensions

Annuity contract change form (Do not use for Structured Settlements or Terminal Funding/Pensions)
Request ownership, payee or beneficiary changes on your annuity contract. Also update your address, notify us of any name changes, or add a third party to your contract.

Annuitization request for fixed annuities
Use this form to select income payment options and convert your deferred annuity to
irrevocable payments. For fixed annuities only.

Beneficiary change request form - Structured Settlements
Complete a beneficiary change on a Structured Settlement

Certification of trustee powers
Required to show signing authority for contracts owned by a Trust for Genworth Life and Annuity Insurance Company, Genworth Life Insurance Company and Genworth Life Insurance Company of New York.

Declaration of attorney-in-fact 
Required to show signing authority for an Attorney-in-Fact acting under a Power of Attorney for the contract owner. For use with Life Insurance and Annuities only.

Duplicate contract authorization
Request a duplicate copy of a lost or destroyed policy or contract.

Electronic funds transfer (EFT) authorization for direct deposit of annuity payments  
Request annuity payments to be deposited directly into your bank account or to update bank account information for policies or contracts currently having payments deposited via electronic funds transfer.

Fixed annuities required minimum distribution authorization
Request a Required Minimum Distribution from a fixed annuity.

Fixed annuities withdrawal authorization
Request a single withdrawal from a fixed annuity or authorize future transactions to be requested over the telephone by you or an authorized family member.

Immediate annuity to long term care funding request for existing immediate 
annuity contracts

Certify that all or the specified portion of your non-qualified immediate annuity payment will directly fund a LTCI policy.

Restricted beneficiary payout designation for variable annuities
Restrict the payout option for any beneficiary of a variable annuity.

Systematic or auto interest withdrawal request for fixed annuities
Request a systematic or auto interest withdrawal from a fixed annuity.

Tax withholding for annuity payments
Designate the amount of state and federal taxes you want withheld from your annuity payments.

Variable annuity annuitization request form
Use this form to select income payment options and convert your deferred annuity to
irrevocable payments. For variable annuities only.

Variable annuities required minimum distribution authorization
Request a Required Minimum Distribution from a variable annuity.

Variable annuity systematic withdrawal request
Request systematic withdrawals from a variable annuity contract.

Variable annuity withdrawal authorization
Request a single withdrawal from a variable annuity or authorize future transactions to be requested over the telephone by you or an authorized family member.

Long Term Care Insurance forms

Address, name or third party changes
Submit address or name changes for yourself or other parties on your policy, or to add, change or delete a third party listed on your policy.

Electronic funds transfer (EFT) authorization
Request automatic withdrawals from your bank account to pay premiums on long term care insurance policies, or to update bank account information for policies already drafting premiums. 

Health information authorization
An authorization form allowing us to share your health history and related health information with a third party, whom you've designated. 

Coverage change request form 
This form is used to request benefit changes and/or change the payment frequency on a current long term care insurance (LTCI) policy. 

Long Term Care Insurance request for beneficiary change 
Use this form to change the beneficiary on an existing Long Term Care Insurance policy, that has a Return of Premium Rider.

Deferred annuity to LTCI 1035 transfer authorization
Use this form to authorize an exchange from a non-qualified deferred annuity contract to a Long Term Care Insurance policy 

Immediate annuity to long term care insurance funding request for existing immediate annuity contracts with irrevocable assignment 
Use this form to certify that all or the specified portion of your non-qualified immediate annuity payment will directly fund your LTCI policy. 

Life insurance to LTCI 1035 transfer authorization 
Use this form to authorize an exchange from a non-qualified life insurance policy to a long term care insurance policy

 
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