Annuities are issued by Pruco Life Insurance Company, Pruco Life Insurance Company of New Jersey, The Prudential Insurance Company of America (PICA) and Prudential Annuities Life Assurance Corporation (PALAC) (these entities are referred to as 2026

1. Click 'Get Form' to open it in our editor.
2. Begin with SECTION 1: OWNER INFORMATION. Fill in your Annuity Number, email address, and full name. If applicable, include the joint owner's details and contact numbers.
3. In SECTION 2: TYPE OF WITHDRAWAL, select either FULL SURRENDER or PARTIAL SURRENDER. Specify the amount you wish to withdraw and choose between Gross or Net withdrawal options.
4. Proceed to SECTION 3: DESIGNATED INVESTMENT OPTION. Indicate from which investment option(s) you want the withdrawal processed, ensuring percentages total 100%.
5. Complete SECTION 4 if applicable by certifying any disability that may affect tax penalties on your distribution.
6. In SECTION 5: INCOME TAX WITHHOLDING NOTICE AND ELECTION, select your tax withholding preferences for federal and state taxes.
7. Fill out SECTION 6: PAYMENT AND MAILING INSTRUCTIONS with your bank details for direct deposit or specify mailing instructions for a check.
8. Finally, sign in SECTION 7 to confirm your request and ensure all required signatures are included before submitting the form.

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