Variable Universal Life & Fixed Deferred Annuities

Service Forms

The best way to fill out or make changes to your forms is our Self-Service channel on my account. If you need further assistance, we recommend calling our Customer Service Center.

Call Us: 1-800-225-5695

Mailing address:
New York Life Insurance and Annuity Corporation
Variable Products Service Center
Madison Square Station
P.O. Box 922
New York, NY 10159

Variable Universal Life

	Self-Service	Call-Us	Form
Change of Beneficiary Form Use this form to change the beneficiary on your policy. Do not use this form if your policy is a family plan or if it has rider insureds.	Login	Call Us: 1-800-225-5695	Download Mailing address: New York Life Insurance and Annuity Corporation Variable Products Service Center Madison Square Station P.O. Box 922 New York, NY 10159
Change of Beneficiary Form - Multiple Insureds Use this form to change your beneficiary if your policy is a family plan or if it has rider insureds.		Call Us: 1-800-225-5695	Download Mailing address: New York Life Insurance and Annuity Corporation Variable Products Service Center Madison Square Station P.O. Box 922 New York, NY 10159
Statement of Trust Form Use this form to change the ownership of your policy to a Trust.		Call Us: 1-800-225-5695	Download Mailing address: New York Life Insurance and Annuity Corporation Variable Products Service Center Madison Square Station P.O. Box 922 New York, NY 10159
Transfer of Ownership / Designation of Successor Owner Form Use this form to request a transfer of ownership and/or designate a successor owner.		Call Us: 1-800-225-5695	Download Mailing address: New York Life Insurance and Annuity Corporation Variable Products Service Center Madison Square Station P.O. Box 922 New York, NY 10159
Transfer of Ownership Kit Use this kit to transfer ownership, setup a Check-O-Matic arrangement to pay your premiums, and change your beneficiary.		Call Us: 1-800-225-5695	Download Mailing address: New York Life Insurance and Annuity Corporation Variable Products Service Center Madison Square Station P.O. Box 922 New York, NY 10159
Loan Request Form Use this form to request a Loan against your policy.	Login	Call Us: 1-800-225-5695	Download Mailing address: New York Life Insurance and Annuity Corporation Variable Products Service Center Madison Square Station P.O. Box 922 New York, NY 10159
Partial Withdrawal Request Form Use this form to request a Partial Withdrawal. Do not use this form for a Full Surrender.	Login	Call Us: 1-800-225-5695	Download Mailing address: New York Life Insurance and Annuity Corporation Variable Products Service Center Madison Square Station P.O. Box 922 New York, NY 10159
One-Time Total Reallocation, Future Payment Allocation, Automatic Asset Rebalancing, Individual Fund Transfer & Change of Expense Use this form to: a) Change how future premiums are applied. b) Select or Change how expense charges are deducted. c) Transfer funds from one Investment Division and/or Fixed Account to another.	Login	Call Us: 1-800-225-5695	Download Mailing address: New York Life Insurance and Annuity Corporation Variable Products Service Center Madison Square Station P.O. Box 922 New York, NY 10159
My Payment Preferences Form Use this form to set up a payment arrangement in which premiums are paid monthly by automatically deducting the money directly from your checking account.	Login	Call Us: 1-800-225-5695	Download Mailing address: New York Life Insurance and Annuity Corporation Variable Products Service Center Madison Square Station P.O. Box 922 New York, NY 10159
Dollar Cost Averaging Form Use this form to establish DCA on a policy and/or make a change to an existing DCA arrangement.		Call Us: 1-800-225-5695	Download Mailing address: New York Life Insurance and Annuity Corporation Variable Products Service Center Madison Square Station P.O. Box 922 New York, NY 10159
Interest Sweep Form Use this form to elect the Interest Sweep option. This option provides for the interest earned on monies allocated to the Fixed Account to be transferred from the Fixed Account to any combination of Investment Divisions.		Call Us: 1-800-225-5695	Download Mailing address: New York Life Insurance and Annuity Corporation Variable Products Service Center Madison Square Station P.O. Box 922 New York, NY 10159
Name Change Request Form Use this form to process a change of Name on your policy.		Call Us: 1-800-225-5695	Download Mailing address: New York Life Insurance and Annuity Corporation Variable Products Service Center Madison Square Station P.O. Box 922 New York, NY 10159
Telephone Authorization Form Use this form to initiate telephone authorization to access information and/or process transactions over the telephone.		Call Us: 1-800-225-5695	Download Mailing address: New York Life Insurance and Annuity Corporation Variable Products Service Center Madison Square Station P.O. Box 922 New York, NY 10159
IRS Form W-4P - Withholding Certificate for Pension or Annuity Payments Use this form for all annuity contract death claims.		Call Us: 1-800-225-5695	Download Mailing address: New York Life Insurance and Annuity Corporation Variable Products Service Center Madison Square Station P.O. Box 922 New York, NY 10159
IRS Form W-9 - Request for Taxpayer Identification Number and Certification Use this form to: certify that the Taxpayer Identification Number (TIN) you are giving is correct (or you are waiting for a number to be issued); certify that you are not subject to backup withholding; or claim exemption from backup withholding if you are a U.S. exempt payee.		Call Us: 1-800-225-5695	Download Mailing address: New York Life Insurance and Annuity Corporation Variable Products Service Center Madison Square Station P.O. Box 922 New York, NY 10159
Instructions for the Requester of Form W-9 Instructions to complete the IRS Form W-9.		Call Us: 1-800-225-5695	Download Mailing address: New York Life Insurance and Annuity Corporation Variable Products Service Center Madison Square Station P.O. Box 922 New York, NY 10159
IRS Form W-8BEN - Certificate of Foreign Status of Beneficial Owner for United States Tax Withholding Use this form if the beneficiary for a death claim is a non U.S. citizen residing abroad.		Call Us: 1-800-225-5695	Download Mailing address: New York Life Insurance and Annuity Corporation Variable Products Service Center Madison Square Station P.O. Box 922 New York, NY 10159

Fixed Deferred Annuities

	Call-Us	Form
Policy Change Request Form	Call Us: 1-800-225-5695	Download Mailing address: New York Life Insurance and Annuity Corporation Variable Products Service Center Madison Square Station P.O. Box 922 New York, NY 10159
Clear Income FDA Withdrawal Form (covers PWs, PPWs and surrenders)	Call Us: 1-800-225-5695	Download Mailing address: New York Life Insurance and Annuity Corporation Variable Products Service Center Madison Square Station P.O. Box 922 New York, NY 10159
Periodic Partial Withdrawal/Partial Withdrawal Request Use this form to make a Partial Withdrawal or set up or modify an automated Periodic Partial Withdrawal Arrangement. To make a partial withdrawal from a Tax-Sheltered Annuity, please contact a Customer Service Representative at (800) 598-2019.	Call Us: 1-800-225-5695	Download Mailing address: New York Life Insurance and Annuity Corporation Variable Products Service Center Madison Square Station P.O. Box 922 New York, NY 10159
Periodic Partial Withdrawal/Partial Withdrawal Request for Tax Sheltered Annuities	Call Us: 1-800-225-5695	Download Mailing address: New York Life Insurance and Annuity Corporation Variable Products Service Center Madison Square Station P.O. Box 922 New York, NY 10159
Name Change Request Form Use this form to process a change of Name on your policy.	Call Us: 1-800-225-5695	Download Mailing address: New York Life Insurance and Annuity Corporation Variable Products Service Center Madison Square Station P.O. Box 922 New York, NY 10159
Direct Deposit Form	Call Us: 1-800-225-5695	Download Mailing address: New York Life Insurance and Annuity Corporation Variable Products Service Center Madison Square Station P.O. Box 922 New York, NY 10159
Change of Beneficiary Form Use this form to change the beneficiary on your policy. Do not use this form if your policy is a family plan or if it has rider insureds.	Call Us: 1-800-225-5695	Download Mailing address: New York Life Insurance and Annuity Corporation Variable Products Service Center Madison Square Station P.O. Box 922 New York, NY 10159
Statement of Trust Form Use this form to change the ownership of your policy to a Trust.	Call Us: 1-800-225-5695	Download Mailing address: New York Life Insurance and Annuity Corporation Variable Products Service Center Madison Square Station P.O. Box 922 New York, NY 10159
Transfer of Ownership/Designation of Successor Owner Use this form to request a transfer of ownership and/or designate a successor owner.	Call Us: 1-800-225-5695	Download Mailing address: New York Life Insurance and Annuity Corporation Variable Products Service Center Madison Square Station P.O. Box 922 New York, NY 10159
My Payment Preferences Form Use this form to set up a payment arrangement in which premiums are paid monthly by automatically deducting the money directly from your checking account.	Call Us: 1-800-225-5695	Download Mailing address: New York Life Insurance and Annuity Corporation Variable Products Service Center Madison Square Station P.O. Box 922 New York, NY 10159
Telephone Authorization Form Use this form to initiate telephone authorization to access information and/or process transactions over the telephone.	Call Us: 1-800-225-5695	Download Mailing address: New York Life Insurance and Annuity Corporation Variable Products Service Center Madison Square Station P.O. Box 922 New York, NY 10159

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Service Forms

Variable Universal Life

Fixed Deferred Annuities

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