Annuity Forms

Annuity Insurance Forms

Browse Genworth’s collection of annuity forms below. Once you locate the appropriate annuity form, download and complete in full. Once you’ve printed it out, please sign and return it to the address found directly on the annuity form. If you have not already done so, please download Adobe Reader® to view the forms.


Are you looking for one of these forms?

These are the top three most downloaded annuity forms. We've listed them here for your convenience. If the form you are looking for is not one of these three, all other long term care insurance forms are listed on this page, below.


Genworth's annuity forms will assist you with making changes to your contract. These forms will help you conduct annuity authorizations, requests, name/address change, naming a beneficiary and other updates to your deferred, variable and fixed index annuity accounts.

Address change form for Structured Settlements or Terminal Funding/Pensions

Agent Change Request
Use to request a change to the Servicing agent on your contract(s).

Annuity contract change form (Do not use for Structured Settlements or Terminal Funding/Pensions)
Request ownership, payee or beneficiary changes on your annuity contract. Also update your address, notify us of any name changes, or add a third party to your contract.

Annuitization request for fixed annuities
Use this form to select income payment options and convert your deferred annuity to irrevocable payments. For fixed annuities only.

Beneficiary change request form - Structured Settlements
Complete a beneficiary change on a Structured Settlement.

Kentucky Annuity Buyer's Guide
A guide to saving money when shopping for annuities.

NAIC Buyer's Guide (Fixed Deferred Annuities)
A guide to saving money when shopping for fixed annuities.

NAIC Buyer's Guide (Deferred Annuities)
A guide to saving money when shopping for annuities.

Certification of trustee powers
Required to show signing authority for contracts owned by a Trust for Genworth Life and Annuity Insurance Company, Genworth Life Insurance Company and Genworth Life Insurance Company of New York.

Declaration of attorney-in-fact
Required to show signing authority for an Attorney-in-Fact acting under a Power of Attorney for the contract owner. For use with Life Insurance and Annuities only.

Duplicate contract authorization
Request a duplicate copy of a lost or destroyed policy or contract.

Electronic funds transfer (EFT) authorization for direct deposit of annuity payments 
Request annuity payments to be deposited directly into your bank account or to update bank account information for policies or contracts currently having payments deposited via electronic funds transfer.

Fixed annuities required minimum distribution authorization
Request a Required Minimum Distribution from a fixed annuity.

Fixed annuities withdrawal authorization
Request a single withdrawal from a fixed annuity or authorize future transactions to be requested over the telephone by you or an authorized family member.

Fixed Index Annuity Reallocation Request
Use form to reallocate among the available interest Crediting Strategies.

 

Immediate annuity to long term care funding request for existing immediate annuity contracts
Certify that all or the specified portion of your non-qualified immediate annuity payment will directly fund a LTCI policy.

Single premium immediate annuity Income Advance/Early Advance request form
Request an Income Advance or Early Advance on an immediate annuity contract.

Single premium immediate annuity commutation form
Use this form to exercise the commutation feature on a single premium immediate annuity.

Restricted beneficiary payout designation for variable annuities
Restrict the payout option for any beneficiary of a variable annuity.

Systematic or auto interest withdrawal request for fixed annuities
Request a systematic or auto interest withdrawal from a fixed annuity.

Tax withholding for annuity payments
Designate the amount of state and federal taxes you want withheld from your annuity payments.

Variable annuity annuitization request form
Use this form to select income payment options and convert your deferred annuity to irrevocable payments. For variable annuities only.

Variable annuities required minimum distribution authorization
Request a Required Minimum Distribution from a variable annuity.

Variable annuity systematic withdrawal request
Request systematic withdrawals from a variable annuity contract.

Variable annuity withdrawal authorization
Request a single withdrawal from a variable annuity or authorize future transactions to be requested over the telephone by you or an authorized family member.

Variable Annuity Trade form
Use to request a transfer of current investments in your variable annuity contract.

206401C2D 03/21/18