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Billing Forms: Life Insurance

Policy Loan Request        Form # 15035
Aviva Life and Annuity Company
Used by policy owners to request a loan from their life insurance policy.

  Download PDF (38 KB)

Policy Loan Request Form        Form # BL-093
Aviva Life and Annuity Company of New York
Used by policy owners to request a loan from their life insurance policy.

  Download PDF (43 KB)

Bank Authorization Form        Form # 15036
Aviva Life and Annuity Company and Aviva Life and Annuity Company of New York
To have your premium payments automatically deducted from your checking account, submit this form and a void check or Specification Sheet from your account. Please contact the Home Office at least five days prior to your draft date for any changes to an existing Pre-Authorized Check agreement.

  Download PDF (202 KB)

W-9 Taxpayer ID Form        Form # 9393
Aviva Life and Annuity Company, Aviva Life and Annuity Company of New York, and former American Investors Life Insurance Company, Inc.
Used by policy owners to certify their TID# of SS# is correct for the purpose of proper tax reporting.

  Download PDF (37KB)

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