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Click ‘Get Form’ to open it in the editor.
Begin by filling out the Owner/Participant Information section. Enter your contract number, name, taxpayer identification number, and contact details.
Indicate whether an Agent/Broker recommended the surrender by selecting 'Yes' or 'No'. This is particularly important for Florida contracts.
In the Distribution Instructions section, choose how you want the proceeds paid. Options include direct deposit or a check sent to your address.
Complete any additional elections if necessary, such as specifying a future processing date for your withdrawal.
Fill out the Withholding Election & Tax Reporting Information section to indicate your preferences regarding tax withholding on distributions.
Review all information for accuracy before signing in the Agreements & Signatures section. Ensure that all required signatures are included.

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