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Click ‘Get Form’ to open the Request to Withdraw Dividends in the editor.
Begin by filling out the Policy Information section. Enter your policy number and the insured's full legal name, including any suffix.
In the Owner Information section, provide your full legal name, Taxpayer Identification Number, and contact details. If applicable, check the boxes for text and email notifications regarding your request.
Proceed to the Withdraw/Apply Dividends section. Select which dividends you wish to withdraw or apply and specify amounts as needed.
Complete the Delivery Information section if you are opting for cash withdrawals. Choose how you would like to receive your payment and provide necessary mailing details.
In the Withholding Election section, decide whether you want federal income tax withheld from your distribution.
Finally, review the Agreements & Signatures section. Ensure all required signatures are provided before submitting your form.

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