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Beneficiary Forms: Annuities

Additional Beneficiaries Designation-Supplement to Beneficiary Change Request        Form # 17963
Aviva Life and Annuity Company and Aviva Life and Annuity Company of New York
Use this form to elect Additional Beneficiaries for your contract(s), if you do not have enough space on Form 13977 (Beneficiary Change Request).

  Download PDF (244 KB)

Beneficiary Change Request        Form # 13977
Aviva Life and Annuity Company
Use the change beneficiary form to change a primary or contingent beneficiary.

  Download PDF (181 KB)

Trust Verification Form        Form # 16541
Aviva Life and Annuity Company and former American Investors Life Insurance Company, Inc.
Used by policy owners, in lieu of the complete copy of the trust, to certify the name, date and trustees of their trust.

  Download PDF (25 KB)

Beneficiary Forms: Life Insurance

Change of Beneficiary Form        Form # 13977
Aviva Life and Annuity Company and Aviva Life and Annuity Company of New York
Use the change of beneficiary form to change a primary or contingent beneficiary designation.

  Download PDF (182 KB)

Information Sharing Agreement        Form # 81061
Aviva Life and Annuity Company
Use this form to agree to an information sharing agreement.

  Download PDF (174 KB)

Information Sharing Agreement Non-Approved Provider        Form # 81060
Aviva Life and Annuity Company
Use this form to agree to an information sharing agreement with a non-approved provider.

  Download PDF (167 KB)

Trust Verification Form        Form # 16541
Aviva Life and Annuity Company and former American Investors Life Insurance Company, Inc.
Used by policy owners, in lieu of the complete copy of the trust, to certify the name, date and trustees of their trust.

  Download PDF (25 KB)

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