Midwestern United Life Insurance Company, Indianapolis, IN 2025

1. Click ‘Get Form’ to open the Surrender Application in the editor.
2. Begin by filling out the Owner Information section. Enter the Insured Name and Owner Name, including first, middle initial, and last names. Provide the Owner SSN/TIN and Policy/File Code Number.
3. In Section 1, confirm your intention to surrender the policy by checking the appropriate box. Ensure you understand that this action will be effective as per your policy’s provisions.
4. Indicate whether any proceeds will fund a new life insurance or annuity by selecting 'Yes' or 'No'. If 'Yes', specify the company providing the new policy.
5. Complete the Withholding Elections section carefully. Choose whether to withhold federal and state taxes as applicable, ensuring you understand potential tax implications.
6. If applicable, complete Section D regarding community property state requirements and ensure all necessary signatures are obtained.
7. Finally, review all entries for accuracy before signing at the bottom of the form. Make sure to provide your daytime phone number and address for tax purposes.

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