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Annuity Forms

Electronic Funds Transfer Form Form # 50276
Aviva Life and Annuity Company (formerly American Investors Life Insurance Company, Inc.)
Bank authorization for direct deposit.

Download PDF (68 KB)

Electronic Funds Transfer Form Form # 10054
Aviva Life and Annuity Company
Bank authorization for direct deposit.

Download PDF (200 KB)

Request for Service Form Form # 57201
Aviva Life and Annuity Company (formerly American Investors Life Insurance Company, Inc.)
Transfer of ownership, name contingent owner, change of name, address change, or beneficiary change.

Download PDF (197 KB)

Request for Service Form Form # 13978
Aviva Life and Annuity Company
Use when customer requests systematic withdrawals, to name contingent owner, change of name, address change, or beneficiary change.

Download PDF (26 KB)

Required Minimum Distribution Request Form Form # 53000
Aviva Life and Annuity Company (formerly American Investors Life Insurance Company, Inc.)
Use when minimum withdrawals are required for distribution.

Download PDF (293 KB)

Required Minimum Distribution Request Form Form # 10042
Aviva Life and Annuity Company
Use when minimum withdrawals are required for distribution.

Download PDF (466 KB)

Systematic Withdrawal Form Form # 83000
Aviva Life and Annuity Company
Use when customer requests systematic withdrawals.

Download PDF (127 KB)

Systematic Withdrawal Form Form # 57200
Aviva Life and Annuity Company (formerly American Investors Life Insurance Company, Inc.)
Use when customer requests systematic withdrawals.

Download PDF (109 KB)

Transfer of Ownership Form Form # 13977
Aviva Life and Annuity Company
Use when customer requests a transfer of ownership.

Download PDF (19 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)

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)

Withdrawal or Surrender Form Form # 53069
Aviva Life and Annuity Company (formerly American Investors Life Insurance Company, Inc.)
Use to withdraw or surrender a single premium or flexible premium annuity.

Download PDF (23 KB)

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