Multi-Year Guaranteed Annuity Agent Forms

The Multi-Year Guaranteed Annuity (MYGA) is available only in Arizona, Oklahoma, and Utah.

MYGA Forms

Form Name Form #
Agent Checklist   * REQUIRED * 3005
MYGA Application 3010
MYGA Agent’s Guide 3007
MYGA Disclosure Statement 3020
Annuity Products Suitability Analysis 1530
Non-Investment Advice and Advertising Acknowledgement 1775
Patriot Act Information 1524
Buyer’s Guide to Fixed Annuities 3072
Applicant Age 80+ Senior Suitability Acknowledgement 1780
Replacement of Life Insurance or Annuity 2050
Qualified / IRA Transfer Form 1535
Non-Qualified / 1035 Exchange Form 1770
Application Additional Beneficiaries Form 1514
Change of Beneficiary Form 2071
Certification of Trust 1512
Full, Partial, RMD, or Systematic Withdrawal Request 1594
Bank Withdrawal Authorization Form for Single Premium 1585
Premium Payment Receipt 2015
3rd Party Authorization to Release Information 3100
MYGA Sample Contract 3000
MYGA Sample Market Value Adjustment Rider MVA
MYGA Sample Penalty-Free Death Benefit Rider PFDB
MYGA Sample Penalty-Free Percentage Amount Withdrawal Rider PFPA
MYGA Customer Interest Rates Flyer 3083
MYGA Customer Reference Guide 3082
MYGA Customer Brochure 3098
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