Company name change request: Fill out & sign online

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Click ‘Get Form’ to open the Address Name Change Request Form in the editor.
Select the request type by checking the appropriate boxes for 'Address Change' and/or 'Name Change'.
In the 'ANNUITANT(S) INFORMATION' section, fill in your first name, middle name, last name, telephone number, birth date, and social security number.
If you are changing your address, provide both your old and new addresses in the 'CHANGE OF ADDRESS INFORMATION' section. Ensure to include street address, city, state, and ZIP code for both.
For a name change, complete the 'CHANGE OF NAME INFORMATION' section. Indicate the reason for change and attach any required legal evidence. Fill in your former name and signature as well as your new name and signature.
Review the 'AUTHORIZATION' statement to confirm that all information is accurate before signing in the 'SIGNATURES' section. Include your printed name and date.

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