Financial Advisors: please check with your firm to determine if suitability forms are needed.
Application Packet
1Consists of instructions, application and producer’s statement. Must be completed and submitted.
Based on jurisdiction.
To find the correct packet, filter by state on our Literature page.
W-4P Withholding Certificate
1Federal income tax withholding form and worksheet. This form is updated annually.
1W-4P
1NAIC Replacement Form
1Must be completed and submitted with the application. Follow state replacement regulations and check for any form specific to your state. For New York, complete the NY Definition of Replacement and the NY Regulation 60 Kit.
1ANN22190
1Important Notice to Military Servicemembers and their Dependents
Must be completed and submitted for Florida residents only.
Roth IRA Acknowledgement
1Must be completed for Roth IRA purchased using new money and attached to the application.
1ANN19001
1Inherited Non-Qualified Exchange Form
1Use when the proceeds are an Inherited Non-Qualified Annuity.
ANN19084
1Inherited Non-Qualified Disclosure Statement
1Review when the proceeds are an Inherited Non-Qualified Annuity.
ANN19085
1Certificate of Deposit/Mutual Fund Redemption and Transfer Form
Use when the proceeds are part of a transfer.
Transfer/Direct Rollover Form
Use when the proceeds are a qualified transfer or rollover.
Inherited IRA Information/Transfer
Use for Inherited Individual Retirement Annuity Account (IRA) Transfers.
1ANN18752
Inherited IRA Information Disclosure Statement
Use for Inherited Individual Retirement Annuity Account (IRA) Transfers.
ANN18831
External Roth IRA Conversion Form
Use when requesting a full or partial conversion from an eligible retirement plan held by an external financial institution to a new NYLIAC Roth IRA.
ANN18738
Internal NYLIAC Annuity Roth IRA Conversion Form
Use when requesting a full or partial conversion from an internal qualified NYLIAC annuity policy to a new NYLIAC Roth IRA annuity policy.
Income Annuity Replacement Acknowledgement and Disclosure
1Must be completed if replacing an existing deferred annuity with an income annuity.
1NYL Privacy Information
Must be left with client. Important Information about Procedures for Opening A New Account.
ANN43088
1Buyer’s Guide for Deferred Annuities
Must be left with client. Only applicable to specific states.
19008
GLIA II Contract Summary
1Must be left with client. Check for any form specific to your state.
118970
(Note: certain states, including NJ and NY, require specific forms.)
GPIA II Contract Summary
1Must be left with client. Check for any form specific to your state.
118979
(Note: certain states, including NJ, require specific forms.)
To view all available forms, visit the Literature search.