Withdraw from a Qualified Annuity Contract | F&G Forms

Manage Policies

Withdraw from a qualified annuity contract (request disbursement)

Instructions

Follow the instructions to surrender or withdraw funds from a qualified annuity contract.

  1. 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 4 on form admin 5588.
  2.  
  3. Type of surrender
    Check the box for only one surrender type. The options are Partial Surrender or Full Surrender. If you are transferring to a traditional IRA to a Roth IRA, check the "Full Surrender" option along with the "Traditional IRA Transfer to Roth IRA" option. There are 4 options for partial surrenders: Maximum available partial, Maximum "penalty free" amount, interest only or a specific amount. Please only choose one option.
  4.  
  5. Signatures
    If there are joint owners on the policy they must both sign the withdrawal request. If the policy is corporately owned the signatures of two officers and their titles must be provided. Request from a POA require that Fidelity & Guaranty Life Insurance Company have current, less than 6 months, POA documentation.
  6.  
  7. Submit form
    Return the completed forms with any required documentation via U.S. mail, overnight mail or fax to F&G 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
  8.  
  9. Allow 15 days to process
    F&G will process the request within 15 business days of receipt of all required information.
  10.  
  11. Payment
    Unless noted otherwise a check will be mailed to the owner's address of record.
  12.  
admin 5588
Request for Disbursement - Qualified Annuities
[admin 5588]
Download Form
18-1259