Forms - New York

Several of our most popular transactions are available to request and submit entirely online:

• One-time Withdrawal
• Systematic Withdrawals
• Address Changes
• Portfolio Navigator Changes
• Duplicate Statement Requests

To complete a transaction online, you must first log in to your contract. Once logged in, go to the Transactions section and select the appropriate transaction.

All online transactions will have the  icon next to the form title.

Print-friendly forms for transfers, payouts and more
All our forms are available as downloadable PDFs. If you can't find the forms you're looking for, contact us.

Please note: We only accept original documents for outgoing trustee-to-trustee transfers, 1035 exchanges, beneficiary changes, death claim statements and surrenders over $100,000. Please do not send fax copies. If you're requesting a 1035 exchange or trustee-to-trustee transfer, we'll need the appropriate forms from the requesting company.

View forms for all other states except New York

	Transaction	In Writing	By fax	By phone	Online
New accounts and additional purchases
Funding	NY - Additional Payment (Add On) Receipt	> Download PDF
	NY - IRA to Roth Conversion	> Download PDF	518.452.3486
	NY - Transfer Roll-over Exchange - Incoming	> Download PDF
	NY - TSA/TSCA Transfer Request	> Download PDF
Non State Specific Required forms	NY - 403(b) Information Sharing Agreement	> Download PDF	518.452.3486
	NY - Tax-Deferred Retirement Plan Acknowledgement	> Download PDF	518.452.3486
State Specific Required Forms	NY - Annuity to Annuity Replacement	> Download PDF	612.547.1858
	NY - Definition of Replacement	> Download PDF	612.547.1858
	NY - Authorization to Disclose	> Download PDF	612.547.2900
	NY - Important Notice Regarding Replacements	> Download PDF	612.547.1858
	NY - Sales Material Checklist for Replacements	> Download PDF	612.547.1858
Withdrawals
Additional Forms	NY - Statement of Disability	> Download PDF	518.452.3486
Death Claims	NY - Death Claim Statement	> Download PDF
IRA/Qualified Plans	NY - 2011 Required Minimum Distribution	> Download PDF	518.452.3486	1.800.504.0469	Yes (one-time withdrawal)
	NY - 2012 Required Minimum Distribution	> Download PDF	518.452.3486	1.800.504.0469	Yes (one-time withdrawal)
	NY - CD Transfer	> Download PDF	518.452.3486
	NY - Mutual Fund Transfer	> Download PDF	518.452.3486
	NY - Transfer Roll-over Exchange - Outgoing	> Download PDF
NY - 403(b) Distribution	> Download PDF	518.452.3486
Partial/Full Surrenders	NY - Substantially Equal Periodic Payment Withdrawal Request	> Download PDF	518.452.3486
	NY - One-time Withdrawal	> Download PDF	518-452-3486, up to $100,000	1.800.504.0469 (up to $100,000)	Yes (one-time withdrawal)
Systematic Withdrawals	NY - Systematic Withdrawal Options	> Download PDF	518.452.3486	1.800.504.0469	Yes
Contract maintenance
Advisor Specific	NY - Agent of Record Change Change servicing advisor or agent on contract	> Download PDF	518.452.3486
Client Specific	Privacy Notice	> Download PDF
Contract Specific	NY - Customer Service Request (Address, Beneficiary, Name changes, Duplicate Policy, as well as Spousal Existence)	> Download PDF	518.452.3486 (address change only)	1.800.504.0469 (address changes only)	Yes (address change only)
	NY - Affidavit of Lost Annuity Contract	> Download PDF	518.452.3486
	NY - Investment Options Form for contracts purchased on or after 5-1-2007 Portfolio Navigator, Dollar Cost Averaging, Fund Rebalance, Interest Sweep, Fund transfer, Systematic Investment (Add On) set up, change and discontinue.	> Download PDF	518.452.3486	1.800.504.0469	Yes (PN Change)
	NY - Investment Options Form for contracts purchased on or before 4-30-2007 Portfolio Navigator, Dollar Cost Averaging, Fund Rebalance, Interest Sweep, Fund transfer, Systematic Investment (Add On) set up, change and discontinue.	> Download PDF	518.452.3486	1.800.504.0469	Yes (PN Change)
	NY - Joint Non-spousal Ownership	> Download PDF	518.452.3486
	NY - Non-natural Ownership	> Download PDF	518.452.3486
	NY - Transfer of Ownership	> Download PDF	518.452.3486
	NY - Telephone Transaction Authorization Authorization for advisor or agent to request certain transactions on the contract.	> Download PDF	518.452.3486
	NY - Trustee Certificate	> Download PDF	518.452.3486