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Billing Forms: Annuities

Electronic Funds Transfer Form        Form # 50276
Aviva Life and Annuity Company (formerly American Investors Life Insurance Company, Inc.)
Bank authorization for direct deposit.

  Download PDF (68 KB)

Electronic Funds Transfer Form        Form # 10054
Aviva Life and Annuity Company
Bank authorization for direct deposit.

  Download PDF (200 KB)

Required Minimum Distribution Request Form        Form # 53000
Aviva Life and Annuity Company (formerly American Investors Life Insurance Company, Inc.)
Use when minimum withdrawals are required for distribution.

  Download PDF (293 KB)

Required Minimum Distribution Request Form        Form # 10042
Aviva Life and Annuity Company
Use when minimum withdrawals are required for distribution.

  Download PDF (466 KB)

Systematic Withdrawal Form        Form # 83000
Aviva Life and Annuity Company
Use when customer requests systematic withdrawals.

  Download PDF (127 KB)

Systematic Withdrawal Form        Form # 57200
Aviva Life and Annuity Company (formerly American Investors Life Insurance Company, Inc.)
Use when customer requests systematic withdrawals.

  Download PDF (109 KB)

W-9 Taxpayer ID Form        Form # 9393
Aviva Life and Annuity Company, Aviva Life and Annuity Company of New York, and former American Investors Life Insurance Company, Inc.
Used by policy owners to certify their TID# of SS# is correct for the purpose of proper tax reporting.

  Download PDF (37KB)

Billing Forms: Life Insurance

Policy Loan Request        Form # 15035
Aviva Life and Annuity Company
Used by policy owners to request a loan from their life insurance policy.

  Download PDF (38 KB)

Policy Loan Request Form        Form # BL-093
Aviva Life and Annuity Company of New York
Used by policy owners to request a loan from their life insurance policy.

  Download PDF (43 KB)

Bank Authorization Form        Form # 15036
Aviva Life and Annuity Company
To have your premium payments automatically deducted from your checking account, submit this form and a void check or Specification Sheet from your account. Please contact the Home Office at least five days prior to your draft date for any changes to an existing Pre-Authorized Check agreement.

  Download PDF (41 KB)

Pre-Authorized Check Authorization Form        Form # BL-094
Aviva Life and Annuity Company of New York
To have your premium payments automatically deducted from your checking account, submit this form and a void check or Specification Sheet from your account. Please contact the Home Office at least five days prior to your draft date for any changes to an existing Pre-Authorized Check agreement.

  Download PDF (45 KB)

W-9 Taxpayer ID Form        Form # 9393
Aviva Life and Annuity Company, Aviva Life and Annuity Company of New York, and former American Investors Life Insurance Company, Inc.
Used by policy owners to certify their TID# of SS# is correct for the purpose of proper tax reporting.

  Download PDF (37KB)

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