Service Forms
Service Forms
We want to make it easy for you to help your clients
Most Commonly Requested Service Forms
File your required minimum distribution (RMD) election.
Use this form to make changes to your Federal or State tax withholding elections.
Authorize the company to start paying benefits included in a Guaranteed Lifetime Withdrawal Rider
Give Nassau Re authority to share policy information with another party.
Disclosure Authorization for Release of Policy/Contract Information - HO5074AUpdate the address we have on file with your policy. When filling out the form, be sure to include the name of annuitant or insured and the contract/policy number. Choose whether you are changing the address for the owner, annuitant, insured, assignee, or a recipient of a duplicate notice. Provide the name and contact information of the policy owner. This form requires the signature of the owner and joint owner (if any).
Update the account used for direct deposits sent to owner(s) of the policy/contract.
Certify the existence of a trust, as well as current trustees and/or successors.
Certification and Acknowledgement of Trust Agreement - OL4132A
Update the name we have on file with your policy.
Designate individual(s) as new owner(s).
Designate a Non-Individual as new owner.
Designate a trust as new owner.
Ownership Change to a Trust - OL2346E
Note: The Certification and Acknowledgment of Trust form must also be completed and submitted.
Change the beneficiary designation on any of of your life or annuity policies.
Additional Service Forms for client/policyholder use are available on www.nfg.com .
Get information on how to file a claim.
Completed forms can be faxed to (321) 400-6316 or mailed to Nassau Re, PO Box 22012, Albany, NY 12201-2012
.