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Return: Express Mail: AXA Equitable EQUI-VEST Processing Office Suite 1000, 100 Madison St-2026

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The document is a request form for disbursement from AXA Equitable's EQUI-VEST Variable Annuity Series. It outlines the procedures for various types of withdrawals, including minimum amounts, required sections to complete, and tax implications. The form also includes sections for owner information, withdrawal instructions, delivery options, and spousal consent requirements for certain plans. Additionally, it provides details on income tax withholding and exemptions under IRS regulations.

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Click ‘Get Form’ to open it in the editor.
Begin by filling out the 'Owner’s Information' section. Ensure you provide your Certificate/Contract number and select the appropriate type of contract.
In the 'Withdrawals' section, choose your request type (e.g., Withdrawal, Segment Maturity Date Withdrawal) and complete the relevant sections as indicated.
For each withdrawal request, specify the amount and how you wish to prorate your withdrawal. Make sure to follow any additional instructions provided for specific options.
Complete the 'Delivery Options' section by selecting how you would like your payment sent. If opting for Direct Deposit or Wire Transfer, ensure to enter your bank details accurately.
Finally, review all entered information for accuracy before signing in Section 12 to authorize the transaction.

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