Service Forms

Service Forms

We want to make it easy to manage your policy

Most Commonly Requested Forms

Update the address we have on file with your policy. When filling out the form, be sure to include the name of annuitant or insured and the contract/policy number. Choose whether you are changing the address for the owner, annuitant, insured, assignee, or a recipient of a duplicate notice. Provide the name and contact information of the policy owner. This form requires the signature of the owner and joint owner (if any).

  Address Change - OL4016

Update the name of the annuitant we have on file with your policy.

  Annuitant Change - OL4004

Use this form to make changes to your Federal or State tax withholding elections.

  Federal/State Income Tax Withholding Election - OL4753

Authorize release of medical information to Phoenix. This form may be used to authorize release of medical information to Phoenix. If you live in Kansas, Massachusetts, Maine, Minnesota, New Mexico or Vermont, be sure to select the form specific to your state.

  Kansas - OL4076KS

  Massachusetts - OL4076MA

  Maine - OL4076ME

  Minnesota - OL4076MN

  New Mexico - OL4076NM

  Vermont - OL4076VT

  All Others - OL4076

Change the beneficiary designation on any of of your life or annuity policies.

  Beneficiary Designation - OL122A

Automatically deposit checks for premium payment, premium deposit fund, or loan repayment.

  Check-O-Matic Service - OL511

Request that medical records used during the underwriting process be released to the individual whose information is to be released.

  Medical Records Request - OL2473

Update the name we have on file with your policy.

  Name Change - OL3135

Life events ad
Life events ad
Life events ad
Life events ad

Variable Product Forms

Readjust investment allocations by shifting money among subaccounts.

  Asset Rebalancing Request - OL2855

Select an asset rebalancing or a dollar cost averaging investment program for your Phoenix variable annuity.

  Optional Investment Programs for Variable Annuities - OL4061

Request periodic payments from your annuity contract.

  Request for Systematic Withdrawal - OL2166

Request telephone services that can be used to transfer contract/policy values.

  Telephone Transfer Privilege Instruction - OL1416

Change the status of existing funds, change the allocation schedule or change the current election.

  Variable Annuity Allocation Transfer or Change for all others - OL1332A

Use this form to select the subaccount(s) for your premium or loan payment allocation, or choose an asset allocation program for all annuities except Spectrum Edge+

  • California residents cannot select subaccounts that are denoted not available in California.
  • The Guaranteed Interest Account is not available for the Phoenix Income Choice product.
  • You may select MVA as a subaccount option except for the following states: Maine, Maryland New Jersey, New York, Oregon, Pennsylvania, Texas and Washington.
  • MVA is not available for the Phoenix Income Choice product.

  Variable Annuity Premium Allocation - OL4032

Use this form to select the subaccount(s) for your premium or loan payment allocation.

  Variable Universal Life Authorization for Payments, Transfers & Allocations - OL1320I

Agent and Broker Forms

Transfer responsibility for products to another agent or to another broker-dealer.

  Block Transfer Form - OL4168

Inforce Underwriting Forms

Apply for non-smoker rates or non-smoker and neversmoke risk classification.

  Non-Smoker Statement - OL348 6-87

Apply for a change to an existing policy that requires underwriting for items like a change in lifestyle.

  Applications for a Policy Change Fully Underwritten in AK - OL4755AK

  Applications for a Policy Change Fully Underwritten in AZ - OL4755AZ

  Applications for a Policy Change Fully Underwritten in CA - OL4755CA

  Applications for a Policy Change Fully Underwritten in CT - OL4755CT

  Applications for a Policy Change Fully Underwritten in FL - OL4755FL

  Applications for a Policy Change Fully Underwritten in GA - OL4755GA

  Applications for a Policy Change Fully Underwritten in HI - OL4755HI

  Applications for a Policy Change Fully Underwritten in IN - OL4755IN

  Applications for a Policy Change Fully Underwritten in MA - OL4755MA

  Applications for a Policy Change Fully Underwritten in MD - OL4755MD

  Applications for a Policy Change Fully Underwritten in ME - OL4755ME

  Applications for a Policy Change Fully Underwritten in MN - OL4755MN

  Applications for a Policy Change Fully Underwritten in MO - OL4755MO

  Applications for a Policy Change Fully Underwritten in MT - OL4755MT

  Applications for a Policy Change Fully Underwritten in NC - OL4755NC

  Applications for a Policy Change Fully Underwritten in NE - OL4755NE

  Applications for a Policy Change Fully Underwritten in NH - OL4755NH

  Applications for a Policy Change Fully Underwritten in NM - OL4755NM

  Applications for a Policy Change Fully Underwritten in NY - OL4755NY

  Applications for a Policy Change Fully Underwritten in OH - OL4755OH

  Applications for a Policy Change Fully Underwritten in OK - OL4755OK

  Applications for a Policy Change Fully Underwritten in OR - OL4755OR

  Applications for a Policy Change Fully Underwritten in PA - OL4755PA

  Applications for a Policy Change Fully Underwritten in PR - OL4755PR

  Applications for a Policy Change Fully Underwritten in SC - OL4755SC

  Applications for a Policy Change Fully Underwritten in TX - OL4755TX

  Applications for a Policy Change Fully Underwritten in UT - OL4755UT

  Applications for a Policy Change Fully Underwritten in VA - OL4755VA

  Applications for a Policy Change Fully Underwritten in VT - OL4755VT

  Applications for a Policy Change Fully Underwritten in WA - OL4755WA

  Applications for a Policy Change Fully Underwritten in WI - OL4755WI

  Applications for a Policy Change Fully Underwritten in all other states - OL4755

Non-Individual Owner Forms

Designate a Non-Individual as new owner and beneficiary.

  Ownership Change to Non-Individual(s) - OL2346C

Certify the existence of a trust, as well as current trustees and/or successors.

  Certification and Acknowledgement of Trust Agreement - OL4132A

Provide required details about the nature of the trust.

  Plan Disclosure and Agreement - PT352

Certify that an individual is an elected and presently acting officer of entity, such as a corporation.

  Certificate of Incumbency - OL4131

Authorize partners to sign on behalf of partnership that owns a policy for all matters related to the policy.

  Partnership Authorization - OL4363

Relinquish the right, title and interest of the assignee to Phoenix Life Insurance Company for a specific policy on the life of an insured individual

  Assignment Release - 520E

Assign your life insurance policy as collateral for a loan.

  Collateral Assignment Form - 525

Request split-dollar administrative services: preparing collateral assignment or endorsement, or reporting the annual economic benefit.

  Split-Dollar Forms Request/Servicing - OL537

Other Forms

File your required minimum distribution (RMD) election.

  Required Minimum Distribution (RMD) Election Form - OL4041

Apply dividends to pay the balance of premiums becoming due by release of paid-up additions.

  Dividends to Pay Premiums Authorization - OL1236

Request history of all policy account transactions for a specified period of time

  Financial Transcript Request - OL4266

Request a new contract if the original has been lost, misplaced or destroyed.

  Lost Contract Agreement - OL630

Request a change to information or instructions on a policy

  Policy Change Request - OL180A

  Policy Change Request for MO only - OL180AMO

Change a premium-paying policy to a paid-up status.

  Reduced Paid-Up Policy Request - FA26

Restore a lapsed policy to active status.

  Reinstatement Application in AK - OL4374AK

  Reinstatement Application in AZ- OL4374AZ

  Reinstatement Application in CA - OL4374CA

  Reinstatement Application in CT - OL4374CT

  Reinstatement Application in FL - OL4374FL

  Reinstatement Application in GA - OL4374GA

  Reinstatement Application in HI - OL4374HI

  Reinstatement Application in IN - OL4374IN

  Reinstatement Application in HI - OL4374HI

  Reinstatement Application in MA - OL4374MA

  Reinstatement Application in MD - OL4374MD

  Reinstatement Application in ME - OL4374ME

  Reinstatement Application in MI - OL4374MI

  Reinstatement Application in MN - OL4374MN

  Reinstatement Application in MO - OL4374MO

  Reinstatement Application in NC - OL4374NC

  Reinstatement Application in NE - OL4374NE

  Reinstatement Application in NJ - OL4374NJ

  Reinstatement Application in NM - OL4374NM

  Reinstatement Application in NY - OL4374NY

  Reinstatement Application in OH - OL4374OH

  Reinstatement Application in OK - OL4374OK

  Reinstatement Application in OR - OL4374OR

  Reinstatement Application in PA - OL4374PA

  Reinstatement Application in PR - OL4374PR

  Reinstatement Application in SC - OL4374SC

  Reinstatement Application in TX - OL4374TX

  Reinstatement Application in UT - OL4374UT

  Reinstatement Application in VA - OL4374VA

  Reinstatement Application in VT - OL4374VT

  Reinstatement Application in WA - OL4374WA

  Reinstatement Application in WI - OL4374WI

  Reinstatement Application in All Other States - OL4374