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eShip # Form Name Select
128403
Designates a third party to receive information on a life insurance policy. Used in all states except NY.
167910
Use this form to choose distribution options for an annuity.
127844
Used to authorize or decline the automatic telephone privileges to perform certain transactions with a VUL policy for ReliaStar Life Insurance Company, ReliaStar Life Insurance Company of New York or Security Life of Denver Insurance Company. Used in most states except PR.
131454
Used to authorize a third party to make fund changes to a variable life insurance policy.
eShip # Form Name Select
160964
Use to request an increase in face amount, the addition of a rider or an improved premium class. For reinstatements of a VUL policy, use form 175037.
131287
Used to change a beneficiary designation on a life insurance policy.
128623
Use in all states to set up automatic payment of premiums from a customer's bank account.
211842
Use to request an increase in face amount, the addition of a rider or an improved premium class. Approved in DE, GU, ND and SD.
211844
Use to request an increase in face amount, the addition of a rider or an improved premium class.
211846
Use to request an increase in face amount, the addition of a rider or an improved premium class.
211840
Use to request an increase in face amount, the addition of a rider or an improved premium class. In Puerto Rico use for term and UL policies only.
212951
Use to request an increase in face amount, the addition of a rider or an improved premium class.
131355
Used to request change of name, address, premiums, nonforfeiture options, dividend options and non-underwritten coverage changes in all states.
eShip # Form Name Select
131455
Used to assign a policy as collateral in all states.
114079
Use this form to notify Voya of a legal name change, address change or change to a trustee.
131456
Allows assignee to release all rights to a policy currently assigned to them.
131538
Allows a policyowner to transfer ownership to another entity/person. This will not be considered in good order without a W-9 form completed by the new owner. Used in all states.
172765
Use this form for in force policies where a Trust is the owner or primary beneficiary of a life insurance policy. The Trustee(s) and the Grantor/Settlor should complete and execute this form. The Grantor/Settlor is the creator of the trust.
eShip # Form Name Select
211852
Use to apply for reinstatement of a recently lapsed life insurance policy in California.
211850
Use to apply for reinstatement of a recently lapsed life insurance policy.
211854
Use to apply for reinstatement of a recently lapsed life insurance policy.
211848
Use to apply for reinstatement of a recently lapsed life insurance policy. Use only for term and UL policies in Puerto Rico.
212949
Use to apply for reinstatement of a recently lapsed life insurance policy.
211806
Use to apply for reinstatement of a recently lapsed life insurance policy.
211822
Use to apply for reinstatement of a recently lapsed life insurance policy.
eShip # Form Name Select
136179
Use to request a loan on a 403(b) policy.
eShip # Form Name Select
131394
Used to request surrender of a life insurance policy.

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What Is Collateral Assignment of Life Insurance?

Table of contents, key takeaways.

  • Collateral assignment allows you to use a life insurance policy as assurance for a loan. The lender gets the first claim on the death benefit if you default.
  • Permanent life insurance policies like whole and universal life are commonly used since they don't expire.
  • A formal collateral assignment process involves paperwork with the lender and insurer.
  • Benefits include potentially improving loan eligibility and getting a lower interest rate. Drawbacks include reduced death benefits for beneficiaries.
  • Alternatives like borrowing against cash value or taking an unsecured loan may be cheaper than paying for life insurance you don't need.

If you'd like to borrow money through a loan, life insurance could help you qualify and get a lower interest rate. Through something called a collateral assignment of life insurance, you can set up an agreement where your policy pays the lender in case you can't.

Not every lender accepts this arrangement, and there are downsides, notably that your primary beneficiary is no longer first in line for the life insurance death benefit. However, in the right situation, it can be a useful financial strategy. Here's what to know about an assignment of life insurance and how to use it properly.

What Is Collateral?

Collateral is a valuable asset that can be used to secure a loan. When you borrow money, you legally agree to repay the lender, usually with scheduled payments and interest. But the lender is taking a risk that you won't pay them back.

When you put up collateral, the lender can legally take that asset if you don't pay back the debt. Real estate, vehicles, equipment and investment accounts are common examples of loan collateral.

What Is the Collateral Assignment of Life Insurance?

In a collateral assignment of life insurance, you use a life insurance policy to secure a loan. You first set up coverage as usual by applying for and buying some type of life insurance policy with a death benefit. If you already have a policy, you could use that too.

Then you fill out a collateral assignment form with the lender. This gives them the right to use the life insurance benefits to pay themselves back if you don't pay off their loan. This could happen if you default or if you happen to die before paying off the debt. With this assignment, you've agreed to use the life insurance death benefit to pay off the remaining loan balance first.

You'll still select a primary beneficiary , the person or entity you want to receive the insurance payout. But with a collateral assignment, if you die without paying off the loan, the life insurance death benefit pays off the debt first. Only if there's any remaining benefit amount does it go to your listed beneficiary. Once you pay off the debt, the assignment ends, and the life insurance would pay your beneficiary in full as usual.

Can You Use Any Type of Life Insurance?

It depends on what the lender is willing to accept. In theory, you could use any type of life insurance for this arrangement. However, some lenders may only accept permanent coverage, such as whole life or universal life . The reason is that permanent coverage doesn't expire as long as you or the lender make the premium payments. As a result, the lender can make sure they eventually collect the death benefit by making the premium payments themselves (they would add this cost to your outstanding debt). Another reason lenders may prefer permanent life insurance is because it can build cash value, a reserve of money while you're alive. This is another valuable asset the lender could take as repayment.

On the other hand, term life insurance  has a set expiration date. If you outlive the term, the coverage ends. While a lender could accept term life insurance as collateral, they take on the risk that you both fail to pay off the loan and outlive the term. In this case, the lender would lose their collateral and won't be certain to get their money back.

What Are Some Examples Using Life Insurance as Collateral?

Hypothetical scenarios may help better illustrate how life insurance can be used as collateral. Here are two examples to consider:

  • Steve wants to take out a 15-year mortgage for $500,000. He currently does not have any life insurance. He agrees to buy a 15-year term policy  with a death benefit of $500,000 to use as a collateral assignment until he pays off the mortgage. He lists his daughter as the primary beneficiary. Ten years later, he passes away with $150,000 left on his mortgage. The term life insurance will first pay $150,000 to the lender to cover the outstanding debt. The remaining $350,000 will then go to his daughter.
  • Kristi wants to take out a $100,000 personal loan to help start a business. She already owns a $300,000 whole life policy with $25,000 in cash value. She puts this policy up as collateral. Unfortunately, Kristi's business does not succeed, and she is unable to pay back any of the loan. The lender takes over the policy through the collateral assignment. They first take the $25,000 of cash value for repayment. Once Kristi passes away, the lender would use the death benefit to cover the remaining debt. Anything left would go to whoever Kristi listed as the beneficiary.

How Do You Set Up a Collateral Assignment?

While the exact process for setting up this arrangement will depend on your lender and insurer, there are a few common steps. Here are five actions you could take:

1. Review Your Lender's Requirements

You can ask your lender whether they allow a collateral assignment of life insurance. If so, check what they require for this arrangement. For example, do they allow all types of life insurance policies  or only certain ones, like whole life ? If you have an existing policy, would they accept it for the assignment? Or would you need to buy a new policy for this arrangement?

2. Set Up Your Life Insurance Coverage

If you already have life insurance and your insurer is willing to accept it, you could use it for the collateral assignment. If you don't have life insurance or your death benefit isn't large enough, you would need to purchase another policy. Be sure to ask your lender whether they only work with certain life insurance companies.

3. Fill Out the Collateral Assignment Forms

Contact your life insurance company for a collateral assignment form. This form lists information about your loan, such as the amount, the repayment schedule and the lender. Once you and your lender sign this form, your insurer can officially add the lender as the collateral assignee for your policy.

4. Finish Setting Up Your Loan

With your collateral assignment in place, you and the lender would then complete the loan application process. Once you get approved, they would send you the loan funds, secured using your life insurance.

5. Pay Off the Loan to End the Collateral Assignment

You would pay off your debt according to the lenders' payment schedule. Once you've made the final payment, you would contact your life insurance company to let them know. They would confirm with your lender and then end the collateral assignment. From that point on, the death benefit would go to your primary beneficiary, not to the lender.

What Are the Benefits of an Assignment?

  • It can help your chances of qualifying for a loan. You aren't guaranteed to qualify for a loan. Having life insurance as collateral could make the difference for your approval. Collateral can make up for other issues, such as having a low credit score or small down payment.
  • It can reduce your loan interest rate. When you put up collateral, you reduce the financial risk for the lender. This ensures they have another way to get their money back if you miss the loan payments. In exchange, they may offer you a lower interest rate. The numbers could potentially work out where the amount you save in interest is enough to cover your life insurance premiums or more.
  • It can help protect your other assets. You could put up other assets for collateral, such as your home or car. But if you miss payments, the lender could take this property from you. While the same is true for life insurance, you might prefer this approach versus risking your home or your vehicle.

     Optimize your financial strategy by using life insurance as a valuable collateral asset. Get a Life Insurance Quote    

What Are the Possible Drawbacks?

  • It reduces your life insurance benefits. When you have a collateral assignment of life insurance, the lender gets the first priority of collecting it. If your policy has cash value, the agreement might restrict your ability to take it out until you've paid off the debt. If you die without paying off your debt, the death benefit will first go to paying it off. Only if there's any benefit remaining will it go to your beneficiaries.
  • It creates an extra insurance cost. To meet your collateral assignment agreement, you must have life insurance. The life insurance company will charge premiums. This is another cost on top of your loan payments.
  • There is no guarantee of qualifying for life insurance. If you don't already have life insurance, you can try buying a policy for this arrangement. However, you are not guaranteed to qualify. You would need to undergo health underwriting and meet the provider's requirements. If you have health issues, it could drive up the insurance cost and make a collateral assignment not worth it. You could even be denied life insurance.

What Common Mistakes Should be Avoided When Assigning Collateral?

  • Not checking with the lender's requirements first. Your lender might only accept certain types of life insurance policies or ones from specific companies. If you don't check before signing up, you might purchase a policy that the lender won't accept. Then you'd need to start the insurance application process over again before you can take out your loan.
  • Naming the lender as the beneficiary. If you name the lender as your primary beneficiary, the lender is legally entitled to the full amount of your life insurance death benefit when you die. This is true even if the death benefit is larger than your unpaid loan balance. Make sure to go through the proper collateral assignment process so your life insurance only pays off your debt and nothing more. That way, any remaining benefit goes to whoever you've chosen as your beneficiary.
  • Canceling your life insurance before paying off the debt. Your collateral assignment agreement requires you to keep your life insurance in place during the entire life of the loan. If you cancel the policy before then, the lender could increase your interest rate. They could also demand repayment of the entire loan at that moment since you breached the contract.
  • Not having enough coverage for beneficiaries. A collateral assignment reduces the life insurance death benefit for your other beneficiaries, such as your spouse and children. Before using this agreement, make sure you have enough in either life insurance coverage or other assets to cover your final expenses and provide for family members depending on your income.

What Alternatives Could You Use for Your Loan?

  • Use life insurance cash value. If your life insurance has cash value, would it be enough to cover your current financial needs? If so, you could withdraw the life insurance cash value. You could also borrow the money through a loan and then pay it back into your policy to use again in the future. However, both approaches will reduce the size of the death benefit for your beneficiary. You would also owe interest on a loan. If your withdrawal is more than what you paid in premiums, you'd owe income tax for taking out the gains. Compare these costs versus owing interest to a lender.
  • Take out an unsecured loan. You could also see how much it would cost to borrow without putting up collateral. Just keep in mind the loan interest rate would be higher. You can then compare how much extra you would owe in interest versus the cost of paying life insurance. In some cases, it may be less expensive to borrow through an unsecured loan, especially if you don't need life insurance for other reasons.
  • Use other assets. If you own a house, car or an investment account, you could put those up for collateral instead of life insurance. If you've paid off some of your mortgage, you could also borrow using a home equity line of credit. The drawback is that if you miss loan payments, you risk losing your home, car or any other asset you put up for collateral.
  • Find a co-signer. If you are having trouble qualifying for a loan on your own, a co-signer could potentially help. This other person agrees to pay off the loan if you miss payments. This makes it safer for the lender. However, if you miss payments, you could hurt the credit score of the other person. They legally need to pay off the debt too.

Should You Consider a Collateral Assignment of Life Insurance?

A collateral assignment of life insurance can make sense if you already have life insurance or you are healthy enough to qualify for a new policy. It also could be worth using if you have addressed your life insurance needs already. Lastly, this arrangement can make sense if you don't want to risk your other assets or if you don't have any other assets for collateral.

If you don't have life insurance and don't think you could qualify for a new, affordable policy because of health issues, this approach might not be an option. If you have life insurance but don't want to risk not having enough coverage for your beneficiaries, this approach also might not be worth it.

To decide if this approach may be right for you, consider speaking with a financial professional . They can compare your other borrowing options and offer guidance based on your specific needs. If a collateral assignment is the best move, they can also help you with your insurance application.

     Evaluate if using life insurance as collateral aligns with your financial goals. Get a Life Insurance Quote    

  • Withdrawals may be subject to charges, withdrawals of taxable amounts are subject to ordinary income tax, and, if taken before age 59½, may be subject to a 10% IRS penalty.
  • Interest is charged on loans, they may generate an income tax liability, reduce the Account Value and the Death Benefit, and may cause the policy to lapse

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It will take seven to 10 days on average to receive the funds when you cash out your 401(k).

How long does it take to get 401k withdrawal check?

Depending on who administers your 401(k) account (typically a brokerage, bank or other financial institution), it can take between 3 and 10 business days to receive a check after cashing out your 401(k).

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What is a collateral assignment on a life insurance policy?

A collateral assignment of life insurance is a conditional assignment appointing a lender as the primary beneficiary of a death benefit to use as collateral for a loan. If the borrower is unable to pay, the lender can cash in the life insurance policy and recover what is owed.

What is an absolute assignment of a life insurance policy?

Definition: An absolute assignment is the act of complete transfer of the ownership (all rights, benefits and liabilities) of the policy completely to other party without any terms and condition. Description: Absolute assignment shifts the ownership of the insurance policy.

How do I get my money from VOYA?

You can request a withdrawal online at VoyaRetirementPlans.com, or call a Voya Customer Service Associate at (800) 584-6001.

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Administrative

Form #Form NameDescription
VL 13535 Used to grant account access to individuals as named by the client or to establish a Client Care Center password on the clients account. PDF only.
VL 14945-2 Used to submit additional designations of beneficiaries who are minors. Must submit with VL 14945 or application or enrollment form. PDF only.
VL 14945-1 Used to submit additional beneficiary designations that exceed space allotted on VL 14945 or application forms. Must submit with VL 14945 or application form. PDF only.
VL 15169 Used to submit administrative changes to a client account. Changes include name, SSN, address, telephone, date of birth, NQDA ownership and delivery option election.
VL 14945 Used to submit annuity beneficiary designations. Spousal signature notarized or witnessed by a Plan Administrator required for ERISA accounts when a non-spouse is designated as primary beneficiary for more than the allowable percentage under the plan.
VL 23015 The form is required when submitting nonqualified applications where the ownership is a Trust. The form will also be required for subsequent NQDA ownership changes where the new owner is a Trust.
VL 23547 Used and submitted with every Entity, Trust, or any Non-Individual Organization application for VFA and VALIC and VALIC Transfer Rollover Exchange, except VALIC Group Enrollments.
VL 100 Used to submit administrative changes to a client account. Changes include beneficiary change, address, name and duplicate contract request.
VL 18546 Used to describe the forms needed to complete transactions involving External Broker Dealers selling VALIC products.
VL 19725-457 Use to provide additional information for distributions for - military reservists called to active duty, health, long-term care or accident insurance for retired public safety officers, or hardship or UEWs for certain beneficiaries of 457 plans
VL 23547-1 Used to submit additional Trust Donors Trustees or managers and beneficiaries that exceed space allotted on VL 23547 Entity Client Account Form. Must submit with VL 23547.
VL 897 Used when a Power of Attorney related request is being made. This form is used with all VALIC products.
VL 22415 Used to submit beneficiary designations changes for Profile or Inside Edge Accounts only.

Financial Transactions

VL 6730

Used by a client to authorize VALIC to transfer funds to a bank account as specified by the client. PDF only.

VL 250

Used to select the type, annuity benefit, and payment frequency. Note- once selected, the annuity option is irrevocable. This form is used for POWER Index, and Assured Choice (available for Independent Channel Only)

VL 151

Used to initiate the minimum distribution as required by the IRS. This form is used for POWER Index, and Assured Choice which is available in Independent Channel Only.

VL 175

Used to request a direct Rollover of Funds to a new plan type from another Carrier to VALIC. This form is used for POWER Index, and Assured Choice available for Independent Channel. This form is also used for American Pathway Elite products within Forms Bundling.

VL 163

Used to request a partial withdrawal and assignment of proceeds under section code 1035a. This form is used for POWER Index and Assured Choice - available for Independent Channel.

VL 102FI

Used to transfer money into the same plan type for 1035 exchanges. This form is used for Assured Choice(available in Independent Channel Only), Power Index, and American Pathway Elite products.

VL 217

Used to request an agreement or to change or cancel an existing agreement allowing for the preauthorized debit of systematic premiums. This form is used for POWER Index, and Assured Choice (available for Independent Channel Only)

FA5550DSW

Used to establish a systematic withdrawal of a designated amount and frequency. This form is used for POWER Index and Assured Choice (available in Independent Channel Only).

VL 162

Used to request a partial or full cash withdrawal from an annuity contract other than 403(b). Thisa form is used for POWER Index, and Assured Choice (available in Independent Channel Only)

VL 162A

Used to request a partial or full cash withdrawal from a 403(b) plan only. This form is used for Assured Choice (available in Independent Channel Only)

VL 18546

Used to describe the forms needed to complete transactions involving External Broker Dealers selling VALIC products.

VL 19725-457

Use to provide additional information for distributions for - military reservists called to active duty, health, long-term care or accident insurance for retired public safety officers, or hardship or UEWs for certain beneficiaries of 457 plans

VL 897

Used when a Power of Attorney related request is being made. This form is used with all VALIC products.

VL 316-Roth

Used to request an internal Roth IRA conversion of an existing account for American Pathway Elite 4 and 7.

VL 12837

Used to make a withdrawal of funds from 457 plans for unforeseeable emergencies.

VL 22551

Used to initiate a Section 1035 Exchange In from an outside carrier to a VALIC account. Send forms directly to Home office for processing. Home office will obtain signoff on suitability from Regional Compliance Analyst.

VL 6201

Used to select a Payout option (payment frequency and method) when annuitizing a clients account.

VL 8725

Used to initiate distribution of a partial withdrawal, maximum withdrawal or full surrender.

VL 995

Used by a beneficiary to claim proceeds from a participants account after death.

VL 9006

Used to request account combination (different group,plan,subgroup to one account) or internal rollover from one VALIC account to another. For product exchanges use VL9034. Minimum Distribution required prior to rollover if client has attained age 70.5.

VL 5320-MAINT

Used for changes to an existing periodic payment associated with a Required Minimum Distribution (RMD) only.

VL 5320

Used to initiate the minimum distribution for group sponsored plans clients only as required by the IRS.

VL 5320-EZ

Used for RMD set ups for group sponsored plans only clients where VALIC calculated, pro-rata, multi-year automatic recurring payments. Use RMD Maintenance Form for making changes to an existing RMD. Use Beneficiary Distribution form for beneficiary distributions. Do not use this form for IRA plans.

VL 5320-IRA

Used for RMD set ups for IRA only clients where participant calculates RMD payment, prior year payments, non pro-rata fund selection, joint life expectancy calculation, reinvestment into an existing nonqualified deferred annuity. Use RMD Maintenance Form for making changes to an existing RMD. Use Beneficiary Distribution form for beneficiary distributions. Do not use this form for group sponsored plans.

VL 5320-IRA-EZ

Used for RMD set ups for IRA only clients where VALIC calculated, pro-rata, multi-year automatic recurring payments. Use RMD Maintenance Form for making changes to an existing RMD. Use Beneficiary Distribution form for beneficiary distributions. Do not use this form for group sponsored plans.

VC 26126

Used to assist clients in understanding Fixed and Fixed Index Annuities in the following states AL AK AR AZ CO FL GA HI IA ID KY ME MO MT NV NJ NM NC OH OK OR RI SC UT WI and WV. Also required in AL, CO, FL, GA, IA, ME, MO, NH, OH, RI, TX, WI, and WV for Variable Annuities. Must be provided to clients at time of application for the following plan types only IRA, Roth IRA, SEP, Simple IRA and NQDA. Use appropriate guide based on client's state of residence. New Hampshire requires the NAIC buyers guide effective 4/30/2018 with 60 day implementation extension period to 6/30/2018.

VL 11411

Used to provide additional fund selection space as an addendum to Application, Enrollment, Internal Combination or Rollover and Combined Enrollment or Exchange forms. PDF only.

VL 28668

Used when the client has an IRA account and wants to send distribution payments to a qualified 501(c)(3) organization that is eligible to receive tax deductible contributions. Must be used with another VALIC distribution form.

VL 8715

Used to transmit an additional contribution for a client and for providing the client with a receipt. Complete only as needed.

VL 25190

Used by the Independent Channel to transmit an additional contribution for a client and for providing the client with a receipt. Complete only as needed.

VL 25031

Used exclusively by external broker-dealers to liquidate Nonqualified or Non-Insurance accounts and transfer funds to VALIC.

VL 8725-C SONJ

Used to initiate distribution of a partial withdrawal, maximum withdrawal or full surrender.

VL 20795

Used to establish a systematic withdrawal of a designated amount, designated number of years or substantially equal payments. Version 10-2002 includes the Fixed Interest Only option feature and allows for fund selection. Use form VL 20795-LB if the account has a living benefit.

VL 20795-LB

Used for accounts with living benefits to establish a systematic withdrawal of the MAWA or a designated amount less than tor equal to the MAWA. This form should only be used for accounts with living benefits. Use form VL 20795 if the account does not have a living benefit.

VL 18484

Used exclusively by external broker-dealers to transfer-rollover in funds for ALL PLAN TYPES from a client account at another carrier to VALIC.

VL 22140

Used to request withdrawal or distribution for funds for hardship reasons.

VL 600-FA

Used to submit an administrative change of ownership to a client account.

VL 23764

Used for the following (must be same ER group and Plan )-Roll existing VALIC assets to a designated Roth VALIC acct-Roll existing VALIC assets to a designated acct at another provider-Roll assets from another plan provider to a VALIC designated Roth acct.

VL 23554

Used with Premiere 5 and 7, Power Index and (Proflex Independent Channel only) products, to provide proof of extended care in order to waive the contracts early withdrawal charge.

VL 23767

Used with Power Index and (Proflex Independent Channel only) products, to provide proof of terminal illness in order to waive the contracts early withdrawal charge.

Transfer Rollover In

VL 18484

Used exclusively by external broker-dealers to transfer-rollover in funds for ALL PLAN TYPES from a client account at another carrier to VALIC.

VL 26991

Inside Edge Fixed Annuity Application must accompany the Inside Edge custodial application. PDF includes Application, Owner Acknowledgement, Agent Access and Client Profile. Replaces VL 25459.

VL 26991-FL

Inside Edge Fixed Annuity Application must accompany the Inside Edge custodial application. PDF includes Application, Owner Acknowledgement, Agent Access and Client Profile. Replaces VL 25459 for FLorida only.

VL 26991-NJ

Inside Edge Fixed Annuity Application must accompany the Inside Edge custodial application. PDF includes Application, Owner Acknowledgement, Agent Access and Client Profile. Replaces VL 25459 for New Jersey only.

VL 26991-NY

Inside Edge Fixed Annuity Application must accompany the Inside Edge custodial application. PDF includes Application, Owner Acknowledgement, Agent Access and Client Profile.For use in New York only. Replaces VL 25459 NY only

VL 26991-VA

Inside Edge Fixed Annuity Application must accompany the Inside Edge custodial application. PDF includes Application, Owner Acknowledgement, Agent Access and Client Profile. Replaces VL 25459-VA.

VL 26991 (406)

VALIC Fixed Annuity-406 application. PDF includes Application, Owner Acknowledgement, Agent Access and Client Profile. Replaces VL 25459 (406).

VL 26991-FL (406)

VALIC Fixed Annuity-406 application. For use in Florida only. PDF includes Application, Owner Acknowledgement, Agent Access and Client Profile. Replaces VL 25459(406) in Florida Only

VL 26991-NJ (406)

VALIC Fixed Annuity-406 application. PDF includes Application, Owner Acknowledgement, Agent Access and Client Profile. Replaces VL 25459(406) in New Jersey.

VL 26991-NY (406)

VALIC Fixed Annuity-406 Allocation. For use in New York only. PDF includes Application, Owner Acknowledgement, Agent Access and Client Profile. Replaces VL 25459 NY only (406)

VL 26991-VA (406)

VALIC Fixed Annuity-406 Allocation. For use in Virginia only. PDF includes Application, Owner Acknowledgement, Agent Access and Client Profile. Replaces VL 25459-VA (406).

VL 23765-IC

Used when enrolling clients in Group or Individual Annuity products in the state of New York - informing the client regarding VALICs policy of compensating its insurance producers and their role in offering insurance products. Independent Channel.

VL 21719

Inside Edge Mutual Fund Employee enrollment form for IRA enrollment.

SEE REPLACEMENT TAB

See Replacement Tab for access to State Replacement Forms.

VL 259

Required for all VALIC annuity products (fixed, variable, qualified and nonqualified ) being sold to clients who reside in CA and are 65 years of age or older if the product is being sold on the basis of its treatment under the CA Medi-Cal program.

VL 14131

Used when replacing life insurance products, including annuities and with all new business in the following states. AL-AR-AK-AZ-CO-CT-HI-IA-KY-LA-MD-ME-MO-MS-MT-NC-NE-NH-NJ-NM-OH-OR-RI-SC-SD-TX-UT-VT-WI-WV. Replacement

VL 22059

This disclosure form is required if the client has answered YES to being an active duty service member of the United States Armed Forces for all individual non-qualified and IRA applications.

VL 22305

Used to grant account access to Agents as named by the client or to establish a Contact Center password on the clients account. PDF only.

VL 22415

Used to submit beneficiary designations changes for Profile or Inside Edge Accounts only.

VL 22583

Required to establish Investment Advisory Services on a VALIC client account(s).

VL 23303

Used to open an IRA-Roth IRA in the name of a Minor. Affiant agrees to indemnify VALIC, including its agents, employees, successors, and assigns from every claim, demand or suit brought against them.

VL 23431

Used to establish Independent Channel accounts. Must be completed and submitted with every application, VALIC transfer, rollover, exchange, except VALIC group enrollments in a variable product. Distribute form copies as noted in the legend at bottom.

VL 23479

Used to authorize a reduction or termination of a salary reduction agreement for Traditional and Roth IRAs.

VL 25031

Used exclusively by external broker-dealers to liquidate Nonqualified or Non-Insurance accounts and transfer funds to VALIC.

VL 25190

Used by the Independent Channel to transmit an additional contribution for a client and for providing the client with a receipt. Complete only as needed.

VL 26470-A

Required for all Florida transactions when purchasing a fixed annuity product regardless of how it is funded. Signature pages must be signed. Replaces VL 22982-A

VL 26470-B

Required for all Florida transactions when purchasing an annuity product and the source of the money is another annuity. Signature pages must be signed. replaces VL 22982-B

VL 28103

Used when replacing life insurance products, including annuities and with all new business in Virginia.

VC 26126

Used to assist clients in understanding Fixed and Fixed Index Annuities in the following states AL AK AR AZ CO FL GA HI IA ID KY ME MO MT NV NJ NM NC OH OK OR RI SC UT WI and WV. Also required in AL, CO, FL, GA, IA, ME, MO, NH, OH, RI, TX, WI, and WV for Variable Annuities. Must be provided to clients at time of application for the following plan types only IRA, Roth IRA, SEP, Simple IRA and NQDA. Use appropriate guide based on client's state of residence. New Hampshire requires the NAIC buyers guide effective 4/30/2018 with 60 day implementation extension period to 6/30/2018.

VC 22966

Used in the state of Kentucky to assist clients in determining their insurance needs and the products related. Must be provided to the client.

VL 22107

Inside Edge Mutual Fund Employee Enrollment form for 401(a) enrollment.

VL 3526

Used to authorize a reduction of salary to fund a Section 403(b) plan. SRA

VL 3526-ROTH

Used to authorize a reduction of salary to fund a Section 403(b) plan with ROTH deferral available.

VL 14118-ROTH

Used to authorize a salary reduction and deferral of compensation for groups offering both plans to employees with ROTH deferral available.

VL 14118

Used to authorize a salary reduction and deferral of compensation for groups offering both plans to employees. Plan must offer both plans to use this form.

VL 21555

Inside Edge Mutual Fund Employee enrollment form for 403(b) enrollment.

VL 21679

Inside Edge Mutual Fund Inidividual 403(b) Custodial Account Agreement. This document must be provided to individual at application.

VL 4546

Used to authorize a deferral of salary to fund a 401(k) plan.

VL 4546-ROTH

Used to authorize a deferral of salary to fund a 401(k) plan with ROTH deferral available.

VL 21555-TX

Inside Edge Mutual Fund Employee enrollment form for 403(b) enrollment for use in Texas only.

VL 8495

Used for a client to defer compensation pursuant to the Employees Deferred Compensation Plan.

VL 8495-ROTH

Used for a client to defer compensation of a 457(b) Governmental plan pursuant to the Employees Deferred Compensation Plan.

VL 21680

Inside Edge Mutual Fund Individual 457(b) Custodial Account Agreement. This document must be provided to individuals at application.

VL 21706

Inside Edge Mutual Fund Employee Enrollment form for 457(b) enrollment.

VL 21706-TX

Inside Edge Mutual Fund Employee Enrollment form for 457(b)Enrollment for use in Texas only.

VL 26991

Inside Edge Fixed Annuity Application must accompany the Inside Edge custodial application. PDF includes Application, Owner Acknowledgement, Agent Access and Client Profile. Replaces VL 25459.

VL 26991-NJ

Inside Edge Fixed Annuity Application must accompany the Inside Edge custodial application. PDF includes Application, Owner Acknowledgement, Agent Access and Client Profile. Replaces VL 25459 for New Jersey only.

VL 26991-FL

Inside Edge Fixed Annuity Application must accompany the Inside Edge custodial application. PDF includes Application, Owner Acknowledgement, Agent Access and Client Profile. Replaces VL 25459 for FLorida only.

VL 14118

Used to authorize a salary reduction and deferral of compensation for groups offering both plans to employees. Plan must offer both plans to use this form.

VL 14118-ROTH

Used to authorize a salary reduction and deferral of compensation for groups offering both plans to employees with ROTH deferral available.

VL 21680

Inside Edge Mutual Fund Individual 457(b) Custodial Account Agreement. This document must be provided to individuals at application.

VL 26996

Proflex FLEXPDFA will close for new applications - sales in all states. The product will remain open for certain groups in IL and KS until a replacement product can be determined. Replaces VL 25456

VL 16377

Used to establish electronic fund transfers for IRAs, non qual tax deferred annuities (NQDAs) SEPs.

VL 14118

Used to authorize a salary reduction and deferral of compensation for groups offering both plans to employees. Plan must offer both plans to use this form.

VL 14118-ROTH

Used to authorize a salary reduction and deferral of compensation for groups offering both plans to employees with ROTH deferral available.

VL 11411

Used to provide additional fund selection space as an addendum to Application, Enrollment, Internal Combination or Rollover and Combined Enrollment or Exchange forms. PDF only.

VL 10330

Used to authorize salary reductions for SIMPLE 401(k) plans. PDF only. You are responsible for distributing copies as noted in the distribution legend at the bottom of the form.

VL 23180

Required by the Texas Retirement System. This form must accompany any new K-12 403(b) applications for a Series 1 contract. For Independent Channel use only.

VL 23181

Required by the Texas Retirement System. This form must accompany any new K-12 403(b) applications for a Series 5 contract. For Independent Channel use only.

VL 14945-1

Used to submit additional beneficiary designations that exceed space allotted on VL 14945 or application forms. Must submit with VL 14945 or application form. PDF only.

VL 7897

Used only in Florida when replacing life insurance products including annuities funded through values in existing enforce policy with same insurer Instructions on cover page Obtain submit replacement form to expedite processing by redeeming carrier.

VL 10402

Salary Reduction Agreement for SIMPLE IRA plans. PDF only. You are responsible for distributing copies as noted in the distribution legend at the bottom of the form.

VL 12667-NY IC

Used exclusively in New York by Independent Channel Broker-Dealers when replacing an individual annuity or other insurance products. Instructions for distribution of copies and materials are on the cover page of the form. Replacement. PDF includes VL 19176 Authorization To Disclose Information - NY Reg 60

VL 12669-NY IC

Used exclusively in Ney York by Independent Channel Broker Dealers when replacing an individual annuity or other insurance products. Instructions for distribution of copies and materials are on the cover page of the form. Replacement.

VL 12670-NY IC

Used exclusively in New York by the Independent Channel Broker Dealer when replacing an individual annuity or other insurance products. Instructions for distribution of copies and materials are on the cover page of the form. Replacement.

VL 19176-IC

Used exclusively in NY when replacing an individual annuity or othr insurance products to authorize current carrier to release information necessary to complete attached forms pursuant to NY Reg 60. Replacement. PDF includes VL 12667-IC NY Replacement Form for New York - NY 10A

VL 26995

Used by Independent Channel to enroll participants in a qualified GROUP contract. Use state specific for FL, NJ, NY and VA. PDF includes Application and Agent Access. The OA is required in all states. Replaces VL 26443.

VL 26995-FL

Used by Independent Channel to enroll in a qualified GROUP contract in Florida. Use state specific for NJ, NY and VA. PDF includes Application and Agent Access. The OA is required. Replaces VL 26443-FL.

VL 26995-NJ

Used by Independent Channel to enroll participants in a qualified GROUP contract in New Jersey. PDF includes Application and Agent Access. Replaces VL 26443-NJ

VL 26995-NY

Used exclusively by Independent Channel in New York State only to enroll participants in a qualified GROUP contract. Enrollment. PDF includes Owner Acknowledgement and Agent Access forms. Replaces VL 26443-NY

VL 26995-VA

Used by Independent Channel to enroll in a qualified GROUP contract in Virginia. PDF includes Application and Agent Access. Replaces VL 26443-VA.

Replacement

Form #

Form Name

Description

VL 23562

Used in Arkansas for all Individual and Group Annuity contracts when replacing an Individual Fixed Deferred Annuity. Replacement Memorandum must be completed at the point of sale.

VL 14131

Used when replacing life insurance products, including annuities and with all new business in the following states. AL-AR-AK-AZ-CO-CT-HI-IA-KY-LA-MD-ME-MO-MS-MT-NC-NE-NH-NJ-NM-OH-OR-RI-SC-SD-TX-UT-VT-WI-WV. Replacement

VL 12670-NY IC

Used exclusively in New York by the Independent Channel Broker Dealer when replacing an individual annuity or other insurance products. Instructions for distribution of copies and materials are on the cover page of the form. Replacement.

VL 7897

Used only in Florida when replacing life insurance products including annuities funded through values in existing enforce policy with same insurer Instructions on cover page Obtain submit replacement form to expedite processing by redeeming carrier.

VL 7744

Used exclusively in California when replacing life insurance products, including annuities. Instructions are on the cover page. Obtain submit replacement form to expedite processing by redeeming carrier.

VL 7859

Used exclusively in Delaware when replacing life insurance products, including annuities. Instructions are on the cover page. Obtain submit replacement form to expedite processing by redeeming carrier.

VL 8165

Used exclusively in Idaho when replacing life insurance products, including annuities. Instructions are on the cover page. Obtain and submit replacement form to expedite processing by redeeming carrier.

VL 27110

Used exclusively in Illinois, when replacing life insurance products, including annuities. Instructions are on the cover page. Obtain and submit replacement form to expedite processing by redeeming carrier.

VL 7814

Used exclusively in Indiana when replacing life insurance products, including annuities. Instructions are on the cover page. Obtain submit replacement form to expedite processing by redeeming carrier.

VL 14735

Used exclusively in Kansas when replacing life insurance products, including annuities. Instructions are on the cover page. Obtain submit replacement form to expedite processing by redeeming carrier.

VL 7742

Used exclusively in Massachusetts when replacing life insurance products, including annuities. Instructions are on the cover page. Obtain and submit replacement form to expedite processing by redeeming carrier.

VL 7818

Used exclusively in Minnesota when replacing life insurance products, including annuities. Instructions are on the cover page. Obtain submit replacement form to expedite processing by redeeming carrier.

VL 27289

Used exclusively in Nevada when replacing life insurance products and annuities (other than individual fixed deferred annuities). Instructions on the cover page. Obtain and submit replacement form to expedite processing by redeeming carrier.

VL 14715

Used exclusively in Nevada when replacing life insurance products, including annuities. Instructions on the cover page. Submit replacement form to expedite processing by redeeming carrier. Include VL 14715-A when replacing a fixed annuity. Replacement.

VL 12667-NY IC

Used exclusively in New York by Independent Channel Broker-Dealers when replacing an individual annuity or other insurance products. Instructions for distribution of copies and materials are on the cover page of the form. Replacement. PDF includes VL 19176 Authorization To Disclose Information - NY Reg 60

VL 12669-NY IC

Used exclusively in Ney York by Independent Channel Broker Dealers when replacing an individual annuity or other insurance products. Instructions for distribution of copies and materials are on the cover page of the form. Replacement.

VL 7866

Used exclusively in Oklahoma when replacing life insurance products, including annuities. Instructions are on the cover page. Obtain and submit replacement form to expedite processing by redeeming carrier.

VL 7862

Used exclusively in Pennsylvania when replacing life insurance products, including annuities. Instructions are on the cover page. Obtain submit replacement form to expedite processing by redeeming carrier.

VL 27111

Used exclusively in Tennessee when replacing life insurance products, including annuities. Instructions are on the cover page. Obtain and submit replacement form to expedite processing by redeeming carrier.

VL 28103

Used when replacing life insurance products, including annuities and with all new business in Virginia.

VL 8096

Used exclusively in Washington when replacing life insurance products, including annuities. Instructions are on the cover page. Obtain and submit replacement form to expedite processing by redeeming carrier.

VL 7847

Used exclusively in Wyoming when replacing life insurance products, including annuities. Instructions are on the cover page. Obtain and submit replacement form to expedite processing by redeeming carrier.

VL 24844

Used exclusively in Georgia when replacing life insurance products. Instructions are on the cover page. Obtain and submit replacement form to expedite processing by redeeming carrier.

New Account Enrollment

Form #Form NameDescription
VL 26991 Inside Edge Fixed Annuity Application must accompany the Inside Edge custodial application. PDF includes Application, Owner Acknowledgement, Agent Access and Client Profile. Replaces VL 25459.
VL 26991-FL Inside Edge Fixed Annuity Application must accompany the Inside Edge custodial application. PDF includes Application, Owner Acknowledgement, Agent Access and Client Profile. Replaces VL 25459 for FLorida only.
VL 26991-NJ Inside Edge Fixed Annuity Application must accompany the Inside Edge custodial application. PDF includes Application, Owner Acknowledgement, Agent Access and Client Profile. Replaces VL 25459 for New Jersey only.
VL 26991-NY Inside Edge Fixed Annuity Application must accompany the Inside Edge custodial application. PDF includes Application, Owner Acknowledgement, Agent Access and Client Profile.For use in New York only. Replaces VL 25459 NY only
VL 26991-VA Inside Edge Fixed Annuity Application must accompany the Inside Edge custodial application. PDF includes Application, Owner Acknowledgement, Agent Access and Client Profile. Replaces VL 25459-VA.
VL 26991 (406) VALIC Fixed Annuity-406 application. PDF includes Application, Owner Acknowledgement, Agent Access and Client Profile. Replaces VL 25459 (406).
VL 26991-FL (406) VALIC Fixed Annuity-406 application. For use in Florida only. PDF includes Application, Owner Acknowledgement, Agent Access and Client Profile. Replaces VL 25459(406) in Florida Only
VL 26991-NJ (406) VALIC Fixed Annuity-406 application. PDF includes Application, Owner Acknowledgement, Agent Access and Client Profile. Replaces VL 25459(406) in New Jersey.
VL 26991-NY (406) VALIC Fixed Annuity-406 Allocation. For use in New York only. PDF includes Application, Owner Acknowledgement, Agent Access and Client Profile. Replaces VL 25459 NY only (406)
VL 26991-VA (406) VALIC Fixed Annuity-406 Allocation. For use in Virginia only. PDF includes Application, Owner Acknowledgement, Agent Access and Client Profile. Replaces VL 25459-VA (406).
VL 26470-B Required for all Florida transactions when purchasing an annuity product and the source of the money is another annuity. Signature pages must be signed. replaces VL 22982-B
VC 26126 Used to assist clients in understanding Fixed and Fixed Index Annuities in the following states AL AK AR AZ CO FL GA HI IA ID KY ME MO MT NV NJ NM NC OH OK OR RI SC UT WI and WV. Also required in AL, CO, FL, GA, IA, ME, MO, NH, OH, RI, TX, WI, and WV for Variable Annuities. Must be provided to clients at time of application for the following plan types only IRA, Roth IRA, SEP, Simple IRA and NQDA. Use appropriate guide based on client's state of residence. New Hampshire requires the NAIC buyers guide effective 4/30/2018 with 60 day implementation extension period to 6/30/2018.
VL 21719 Inside Edge Mutual Fund Employee enrollment form for IRA enrollment.
VL 22583 Required to establish Investment Advisory Services on a VALIC client account(s).
VL 14131 Used when replacing life insurance products, including annuities and with all new business in the following states. AL-AR-AK-AZ-CO-CT-HI-IA-KY-LA-MD-ME-MO-MS-MT-NC-NE-NH-NJ-NM-OH-OR-RI-SC-SD-TX-UT-VT-WI-WV. Replacement
VL 28103 Used when replacing life insurance products, including annuities and with all new business in Virginia.
VL 25190 Used by the Independent Channel to transmit an additional contribution for a client and for providing the client with a receipt. Complete only as needed.
VL 25031 Used exclusively by external broker-dealers to liquidate Nonqualified or Non-Insurance accounts and transfer funds to VALIC.
VL 23431 Used to establish Independent Channel accounts. Must be completed and submitted with every application, VALIC transfer, rollover, exchange, except VALIC group enrollments in a variable product. Distribute form copies as noted in the legend at bottom.
VL 23479 Used to authorize a reduction or termination of a salary reduction agreement for Traditional and Roth IRAs.
VL 22305 Used to grant account access to Agents as named by the client or to establish a Contact Center password on the clients account. PDF only.
VL 259 Required for all VALIC annuity products (fixed, variable, qualified and nonqualified ) being sold to clients who reside in CA and are 65 years of age or older if the product is being sold on the basis of its treatment under the CA Medi-Cal program.
VL 22059 This disclosure form is required if the client has answered YES to being an active duty service member of the United States Armed Forces for all individual non-qualified and IRA applications.
VL 22415 Used to submit beneficiary designations changes for Profile or Inside Edge Accounts only.
VL 23303 Used to open an IRA-Roth IRA in the name of a Minor. Affiant agrees to indemnify VALIC, including its agents, employees, successors, and assigns from every claim, demand or suit brought against them.
VL 26470-A Required for all Florida transactions when purchasing a fixed annuity product regardless of how it is funded. Signature pages must be signed. Replaces VL 22982-A
VC 22966 Used in the state of Kentucky to assist clients in determining their insurance needs and the products related. Must be provided to the client.
SEE REPLACEMENT TAB See Replacement Tab for access to State Replacement Forms.
VL 23765-IC Used when enrolling clients in Group or Individual Annuity products in the state of New York - informing the client regarding VALICs policy of compensating its insurance producers and their role in offering insurance products. Independent Channel.
VL 18484 Used exclusively by external broker-dealers to transfer-rollover in funds for ALL PLAN TYPES from a client account at another carrier to VALIC.
VL 22107 Inside Edge Mutual Fund Employee Enrollment form for 401(a) enrollment.
VL 21555 Inside Edge Mutual Fund Employee enrollment form for 403(b) enrollment.
VL 21679 Inside Edge Mutual Fund Inidividual 403(b) Custodial Account Agreement. This document must be provided to individual at application.
VL 14118 Used to authorize a salary reduction and deferral of compensation for groups offering both plans to employees. Plan must offer both plans to use this form.
VL 14118-ROTH Used to authorize a salary reduction and deferral of compensation for groups offering both plans to employees with ROTH deferral available.
VL 3526 Used to authorize a reduction of salary to fund a Section 403(b) plan. SRA
VL 3526-ROTH Used to authorize a reduction of salary to fund a Section 403(b) plan with ROTH deferral available.
VL 21555-TX Inside Edge Mutual Fund Employee enrollment form for 403(b) enrollment for use in Texas only.
VL 26991 Inside Edge Fixed Annuity Application must accompany the Inside Edge custodial application. PDF includes Application, Owner Acknowledgement, Agent Access and Client Profile. Replaces VL 25459.
VL 26991-NJ Inside Edge Fixed Annuity Application must accompany the Inside Edge custodial application. PDF includes Application, Owner Acknowledgement, Agent Access and Client Profile. Replaces VL 25459 for New Jersey only.
VL 26991-FL Inside Edge Fixed Annuity Application must accompany the Inside Edge custodial application. PDF includes Application, Owner Acknowledgement, Agent Access and Client Profile. Replaces VL 25459 for FLorida only
VL 21679 Inside Edge Mutual Fund Inidividual 403(b) Custodial Account Agreement. This document must be provided to individual at application.
VL 14118 Used to authorize a salary reduction and deferral of compensation for groups offering both plans to employees. Plan must offer both plans to use this form.
VL 14118-ROTH Used to authorize a salary reduction and deferral of compensation for groups offering both plans to employees with ROTH deferral available.
VL 4546 Used to authorize a deferral of salary to fund a 401(k) plan.
VL 4546-ROTH Used to authorize a deferral of salary to fund a 401(k) plan with ROTH deferral available.
VL 21706 Inside Edge Mutual Fund Employee Enrollment form for 457(b) enrollment.
VL 21680 Inside Edge Mutual Fund Individual 457(b) Custodial Account Agreement. This document must be provided to individuals at application.
VL 8495 Used for a client to defer compensation pursuant to the Employees Deferred Compensation Plan.
VL 8495-ROTH Used for a client to defer compensation of a 457(b) Governmental plan pursuant to the Employees Deferred Compensation Plan.
VL 21706-TX Inside Edge Mutual Fund Employee Enrollment form for 457(b)Enrollment for use in Texas only.
VL 21680 Inside Edge Mutual Fund Individual 457(b) Custodial Account Agreement. This document must be provided to individuals at application.
VL 14118 Used to authorize a salary reduction and deferral of compensation for groups offering both plans to employees. Plan must offer both plans to use this form.
VL 14118-ROTH Used to authorize a salary reduction and deferral of compensation for groups offering both plans to employees with ROTH deferral available.
VL 26995 Used by Independent Channel to enroll participants in a qualified GROUP contract. Use state specific for FL, NJ, NY and VA. PDF includes Application and Agent Access. The OA is required in all states. Replaces VL 26443.
VL 14945-1 Used to submit additional beneficiary designations that exceed space allotted on VL 14945 or application forms. Must submit with VL 14945 or application form. PDF only.
VL 11411 Used to provide additional fund selection space as an addendum to Application, Enrollment, Internal Combination or Rollover and Combined Enrollment or Exchange forms. PDF only.
VL 10330 Used to authorize salary reductions for SIMPLE 401(k) plans. PDF only. You are responsible for distributing copies as noted in the distribution legend at the bottom of the form.
VL 23180 Required by the Texas Retirement System. This form must accompany any new K-12 403(b) applications for a Series 1 contract. For Independent Channel use only.
VL 23181 Required by the Texas Retirement System. This form must accompany any new K-12 403(b) applications for a Series 5 contract. For Independent Channel use only.
VL 26995-FL Used by Independent Channel to enroll in a qualified GROUP contract in Florida. Use state specific for NJ, NY and VA. PDF includes Application and Agent Access. The OA is required. Replaces VL 26443-FL.
VL 7897 Used only in Florida when replacing life insurance products including annuities funded through values in existing enforce policy with same insurer Instructions on cover page Obtain submit replacement form to expedite processing by redeeming carrier.
VL 10402 Salary Reduction Agreement for SIMPLE IRA plans. PDF only. You are responsible for distributing copies as noted in the distribution legend at the bottom of the form.
VL 26995-NJ Used by Independent Channel to enroll participants in a qualified GROUP contract in New Jersey. PDF includes Application and Agent Access. Replaces VL 26443-NJ
VL 26995-NY Used exclusively by Independent Channel in New York State only to enroll participants in a qualified GROUP contract. Enrollment. PDF includes Owner Acknowledgement and Agent Access forms. Replaces VL 26443-NY
VL 12667-NY IC Used exclusively in New York by Independent Channel Broker-Dealers when replacing an individual annuity or other insurance products. Instructions for distribution of copies and materials are on the cover page of the form. Replacement. PDF includes VL 19176 Authorization To Disclose Information - NY Reg 60
VL 12669-NY IC Used exclusively in Ney York by Independent Channel Broker Dealers when replacing an individual annuity or other insurance products. Instructions for distribution of copies and materials are on the cover page of the form. Replacement.
VL 12670-NY IC Used exclusively in New York by the Independent Channel Broker Dealer when replacing an individual annuity or other insurance products
VL 26995-VA Used by Independent Channel to enroll in a qualified GROUP contract in Virginia. PDF includes Application and Agent Access. Replaces VL 26443-VA.
VL 26996 Proflex FLEXPDFA will close for new applications - sales in all states. The product will remain open for certain groups in IL and KS until a replacement product can be determined. Replaces VL 25456
VL 16377 Used to establish electronic fund transfers for IRAs, non qual tax deferred annuities (NQDAs) SEPs.
Form #Form NameDescription
VL 20819 Used to obtain information necessary to determine your eligibility for a loan under a Public Employer 403(b) plan.

Form Annotations

Form #Form NameDescription
VC 24310 Instructions for completing VL 24176.
VC 24311 Instructions for completing VL 23708.
VC 24312 Instructions for completing VL 22305.
VC 24313 Instructions for completing VL 22711.
VC 24314 Instructions for completing VL 18484.
Form #Form NameDescription
VL 26992 Used by Independent Channel to establish New PD Groups Used with Qual and NQDA plans. Form states that the Multi-Year Enhanced Fixed Opt may not be avail in all states and has other disclosures required for an MYO. Use state specific form in MD, NY or VA. Replaces VL 26442.
VL 26992-NY Used only by Indep Chan to estab New PD Groups in NY. This form is for use with Qualified and NQDA plans. Form has disclosures required for MYO. Independent Channel. Replaces VL 26442-NY.
VL 26992-VA Used only by Indep Chan to estab New PD Groups in VA. This form is for use with Qualified and NQDA plans. Form has disclosures required for MYO. Independent Channel. Replaces VL 26442-VA.
VL 15282 Used to establish an administrative service arrangement for 457 Deferred Compensation plans. PDF only.
VL 10421 Used exclusively when the Plan Sponsor intends to -employer direct- assets from their former record keeper to VALIC. PDF only. Must provide VALIC with the most current executed plan document, adoption agreement if applicable and all amendments.
VL 18546 Used to describe the forms needed to complete transactions involving External Broker Dealers selling VALIC products.
VL 15280-IC Used to provide all necessary group related information (payroll contacts, payroll dates, group name address, telephone, etc). For use in the Independent Channel Only. PDF only.
VL 15281 Used in ERISA covered plans to provide disclosure to the Plan Fiduciary for Agent related compensation.
VL 17584 Used for new groups coming into VALIC requesting basic administration services and other optional services. Available as PDF only.
VL 26992-MD Used only by Indep Chan to estab New PD Groups in MD. This form is for use with Qualified and NQDA plans. Form has disclosures required for MYO. Independent Channel. Replaces VL 26442-MD in Maryland Only.
VL 26992-CHOICE Used only by Indep Chan to estab New PD Choice Groups. This form is used with Qual and NQDA plans. Form clearly states the Multi-Yr Enhanced Fixed Opt may not be avail in all states and has other discl reqd for an MYO. Use state spec app for MD, NY or VA. Replaces VL 26442 CHOICE.
VL 26992-MD CHOICE Used only by Indep Chan to estab New PD Groups in MD. This form is for use with Qualified and NQDA plans. Form has disclosures required for MYO. Independent Channel. Replaces VL 26442-MD CHOICE in Maryland Only
VL 26992-NY CH Used only by Indep Chan to estab New PD Choice Groups in NY. This form is for use with Qualified and NQDA plans. Form has disclosures required for MYO. Independent Channel. Replaces VL 26442-NY Choice
VL 26992-VA CH Used only by Indep Chan to estab New PD Groups in VA. This form is for use with Qualified and NQDA plans. Form has disclosures required for MYO. Independent Channel. Replaces VL 26442-VA CHOICE.

 The information contained on this site is intended for financial professionals only and is not an offer to sell, recommend or solicit securities. 

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Client Information

Below is important information about working with Voya Financial Advisors. 

Note: Some files are in PDF format. In order to open, view or print these files, you will need to have Adobe Acrobat Reader installed on your computer. This is available with a free download from the Adobe Systems website . When printing multiple-page documents, please use the two-sided option whenever possible.

  • Client Relationship Summary (PDF )
  • Voya Financial Advisors’ Regulation Best Interest Disclosure (PDF)
  • Voya Financial Advisors’ Privacy Notice (PDF)
  • Your Account Agreement (PDF)
  • Doing Business with Us (PDF)
  • Business Continuity Plan Summary (PDF)
  • Sponsor Fee Disclosure for Retirement Plans Subject to ERISA
  • Documents available for Electronic Delivery for Voya Financial Advisors, Inc. (PDF)
  • Voya Financial Advisors Insured Bank Deposit Account
  • Part 2A of Form ADV: Firm Brochure (PDF)
  • Part 2A Appendix 1 of Form ADV: Wrap Fee Program Brochure (PDF)
  • Schedule of Miscellaneous Account and Service Fees (PDF)
  • Investor Channel Schedule of Miscellaneous Account and Service Fees (PDF)
  • Part 2A Appendix 1 of Form ADV: Investor Channel Wrap Fee Program Brochure

About Voya Financial Advisors

Voya Financial Advisors, Inc., the broker-dealer of Voya Financial, Inc. (NYSE: VOYA), supports a wide range of clients through approximately 600 financial professionals. As a top-tier independent broker-dealer, Voya Financial Advisors is focused on helping Americans advance their retirement readiness through education, financial planning and a broad range of personalized asset accumulation, protection and distribution solutions. Voya Financial is a premier retirement, investment and insurance company serving the financial needs of over 14 million individual and institutional customers in the United States.*

Voya Financial Advisors is required to make available quarterly reports that present a general overview of its order routing practices. These reports identify the significant venues to which client orders were routed for execution during the applicable quarter. Voya Financial Advisors transmits its client orders to its clearing firm, Pershing LLC. Pershing may then route these orders to various venues for execution. To obtain a copy of this report, please visit orderroutingdisclosure.com and enter the full broker-dealer name exactly as follows: Voya Financial Advisors, Inc.

*As of 6/30/2023.

Securities and investment advisory services offered through Voya Financial Advisors, Inc. (member SIPC). See BrokerCheck for more information.

IMAGES

  1. Assignment Of Life Insurance Policy As Collateral

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  2. 2023 Form Voya 83265 Fill Online, Printable, Fillable, Blank

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  4. Do you know what Collateral Assignment is?

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  6. Private Non-Equity Collateral Split-dollar

COMMENTS

  1. Forms Library

    In order to open, view or print these forms you will need to have Adobe Acrobat Reader installed on your computer. This is available with a free download from the Adobe Systems website. When printing multiple-page documents, please use the 2-sided option whenever possible. Completed forms can be mailed, faxed or emailed to customer service for ...

  2. Forms

    Click on a button below to find the forms you need. Skip to main ... Voya Cares - Financial Professionals Enter a keyword in the search field above and your results will be displayed as you type. Main Menu About Us Our Company Our Character Behavioral Finance ...

  3. PDF Assignment of life insurAnce policy As collAterAl

    This assignment is made and the policy is held as collateral security for any and all liabilities of the Assignors, or any of them, tothe Assignee, either ... 2000 21st Ave. NW, Minot, ND 58703; Completed forms can be emailed to: [email protected] Assignee Name Birth Date SSN/TIN Phone ( ) Assignment of life insurAnce policy As collAterAl ...

  4. Voya Presents

    Collateral Assignment Used to assign a policy as collateral in all states. 114079. Policy Maintenance Use this form to notify Voya of a legal name change, address change or change to a trustee. 131456. Release of Assignment Allows assignee to release all rights to a policy currently assigned to them. 131538.

  5. Forms Library

    Administration Forms. The forms provided here are standard Administration forms, other than Claims. Any Enrollment or Application forms must be obtained through your Account Manager. Insurance products in the U.S. are provided by ReliaStar Life Insurance Company (Home and Administration Office: Minneapolis, MN) and ReliaStar Life Insurance ...

  6. PDF Collateral Assignment

    Mailing Instructions: Send form(s) to: Standard Address • PO Box 305355 • Nashville, TN 37230-5355 • Fax: 1-844-930-0370 Variable Life Service Center • PO Box 305600 • Nashville, TN 37230-5600 • Fax: 713-620-6653. 1. POLICY IDENTIFICATION. Check Here if New Address.

  7. PDF Information on Life Insurance Policy Collateral Assignments

    is to fully complete Voya's sample collateral assignment form or to make sure the written information submitted includes everything requested in the Voya form. Links to Voya Life's sample forms are included at the end of this document. For agent use only. Not for public distribution. Warning - Collateral Assignments of Modified Endowment

  8. AUTHORIZATION TO RELEASE INFORMATION

    %PDF-1.7 %âãÏÓ 281 0 obj >stream hÞì[ëS ;²ÿWTû joFï×½§Re0$œáàää,œTjÀ ø ÛÃÚC ö¯ßnI3~àq òe" ¤Ñ£ÕjýºÕ ·¸c„ ! áÜAê ·ð® QÜ@ê‰Öðn 1Â î µ Zhï´"Üshd d •6 Š=47 2@Ï 1î, ÎBc }èʉd@‹;E¤ôØX ©qt/ˆ´ÈŽ‡*¯ Êkà…cÆ % ¶±D)$è QFãèž(Ç`d Œ{ , 'šK, DK%!#a. K ÑVc‰&Ú ó‚ b¼™%F†îŽ 3 @Ô 9#ÆawΉeÐUpA,W0K ...

  9. Brighthouse Financial

    Forms Center. Welcome to the Forms Center, the location for all administrative and policy servicing forms. Visit our Help Center for additional support. Note: Forms contained here have been updated to reflect recent mailing address changes.

  10. What Is Collateral Assignment? How, Pros & Cons, Examples

    3. Fill Out the Collateral Assignment Forms. Contact your life insurance company for a collateral assignment form. This form lists information about your loan, such as the amount, the repayment schedule and the lender. Once you and your lender sign this form, your insurer can officially add the lender as the collateral assignee for your policy. 4.

  11. Forms Library

    Individual Whole Life Required Supplemental Forms and Documents. Find the required forms and documents based on your state of residence for your Voya® Employee Benefits insurance policies. Note: These forms are in PDF format. ... Voya® Employee Benefits insurance products and services in the U.S. are provided by ReliaStar Life Insurance ...

  12. PDF Release of Assignment

    c Split Dollar Collateral Assignment to Date The undersigned hereby releases and relinquishes all of the undersigned's rights, benefits, title and interest in the above policy. ... Website: voya.com; Completed forms can be emailed to: [email protected] ReliaStar Life Insurance Company ("ReliaStar") administers, and is solely ...

  13. PDF Collateral Assignment Form

    Collateral Assignment Form. Use this form to collaterally assign the policy(ies) referenced below. This form must be completed and signed by the Owner. MI Last Sufix. "Company" as referred to herein, is Massachusetts Mutual Life Insurance Company, and/or MML Bay State Life Insurance Com-pany and/or C.M. Life Insurance Company.

  14. PDF Release of Assignment

    Voya Insurance and Annuity Company, Des Moines, IA Members of the Voya® family of companies (the "Company") Customer Service: 2000 21st Ave. NW, Minot, ND 58703 Website: voya.com; Completed forms can be emailed to: [email protected] c Collateral Assignment to Date c Split Dollar Endorsement to Date

  15. Claim Center

    Add forms or documentation to a claim you already started. Upload Forms . Need a form? Find it here. Track a Claim. Check the status of a claim you already submitted. ... Long Term Disability Income Insurance and/or Voya Leave Management claims: 888-305-0602, 8:00am - 6:00pm EST Monday - Friday. Find additional contact information for all other ...

  16. PDF NF Collateral Assignment of Life Insurance or Annuity

    Form AN-331 AMERICAN NATIONAL. RV 05-24. Collateral Assignment of Life Insurance or Annuity. Issued by American National / One Moody Plaza, Galveston, TX 77550-7947. Overnight Address. Annuity Services: Mailing Processing Center, Attn: Annuity 10427, 1949 E. Sunshine St.

  17. PDF Assignment of Life Insurance Policy as Collateral (Premium Finance

    As a result, any earnings in the contract lose their tax-deferred status. You will receive an IRS Form 1099-R reporting the earnings to date as taxable income for the year the contract becomes subject to assignment. You will continue to receive a Form 1099-R each year the assignment remains in force reporting any additional earnings.

  18. Get Assignment Of Life Insurance Policy As Collateral

    Complete Assignment Of Life Insurance Policy As Collateral - Voya For in a few minutes by simply following the instructions below: Find the template you want from the library of legal forms. Select the Get form button to open it and move to editing. Fill in all the required boxes (they are yellow-colored).

  19. Forms

    This form is also used for American Pathway Elite products within Forms Bundling. VL 163. Fixed Annuity Request for a Partial 1035 Exchange. Used to request a partial withdrawal and assignment of proceeds under section code 1035a. This form is used for POWER Index and Assured Choice - available for Independent Channel. VL 102FI

  20. Forms Library

    The forms provided here are standard Administration forms. If any form you need is listed as "TBD" then please contact your Account Representative to order a paper supply as indicated in your Administration Manual. Any Enrollment forms and Evidence of Insurability forms must be obtained through your local Account Representative. Voya Employee ...

  21. Assignment of Life Insurance Policy as Collateral Voya for Form

    Locate assignment of life insurance policy as collateral voya for form and click Get Form to get started. Utilize the instruments we provide to submit your form. Highlight relevant paragraphs of your documents or blackout sensitive data with instruments that airSlate SignNow gives specifically for that function.

  22. Forms Library

    Voya Insights Small Business & Nonprofit Cybersecurity SECURE 2.0 401(k) InfoCenter 403(b) Regulations Leave Resources The Voya Difference Behavioral Finance Voya Cares - Employers

  23. Client Information

    Below is important information about working with Voya Financial Advisors. Note: Some files are in PDF format. In order to open, view or print these files, you will need to have Adobe Acrobat Reader installed on your computer. This is available with a free download from the Adobe Systems website.When printing multiple-page documents, please use the two-sided option whenever possible.