Instructions
Surrender or withdraw funds from a non-qualified annuity contract.
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Complete form
Complete the Request for Disbursement form for all non-qualified annuity policies. Fill out all relevant sections on the form as all incomplete forms will be returned. This includes the tax withholding section on page 3 of the Request for Disbursement form (ADMIN 5587). -
Type of surrender
Check the box for only one surrender type. The options are partial surrender or full surrender. If you are transferring from a traditional IRA to a Roth IRA, check the "Full Surrender" option along with the "Traditional IRA Transfer to Roth IRA" option. There are four options for partial surrenders: maximum available partial, maximum "penalty free" amount, interest only or a specific amount. Please only choose one option. -
Signatures
If there are joint owners on the policy, both must sign the withdrawal request. If the policy is corporately owned, the signatures of two officers and their titles must be provided. Request from a power of attorney (POA) requires that F&G have current (less than 6 months) POA documentation. -
Submit form
Return the completed forms with any required documentation via U.S. mail, overnight mail or fax to our service center.
Postal mail
F&G Service Center
P.O. Box 81497
Lincoln, NE 68501-1497
Overnight mail
F&G Service Center
777 Research Drive
Lincoln, NE 68521
Fax
402.328.2266
Allow 3 business days for faxed documents to enter our processing system. -
Allow 15 days to process
F&G will process the request within 15 business days of receipt of all required information if in good order. -
Payment
Unless noted otherwise, a check will be mailed to the owner's address on record.
Request for Disbursement / Systematic Withdrawal
[ADMIN 5587]
Download ADMIN5587
22-0084