Service Forms

File your required minimum distribution (RMD) election and submit it to the Nassau Service Center.

Required Minimum Distribution (RMD) Election Form - OL4041

File your request for a maturity date postponement and submit it to the Nassau Service Center. Visit Service Forms and enter a policy/contract number to download the appropriate form.

Form number reference: Request for Maturity Date Postponement Form - HO5252

Use this form to make changes to your Federal or State tax withholding elections and submit it to the Nassau Service Center. Visit Service Forms and enter a policy/contract number to download the appropriate form.

Federal/State Income Tax Withholding Election - OL4753

This form ONLY applies to contracts with an issue date of November 1, 2019, or later. For contracts issued prior to November 1, 2019, please call Customer Service at 800-541-0171.

Use this form to authorize the company to start paying benefits included in a Guaranteed Lifetime Withdrawal Rider and submit it to the Nassau Service Center.

Guaranteed Lifetime Withdrawal Rider Activation - OL4467

Use this form to authorize the company to start paying benefits included in the Guaranteed Lifetime Withdrawal Benefit of the Flex-Forward Income Benefit rider and submit it to the Nassau Service Center.

Guaranteed Lifetime Withdrawal - Flex-Forward Income Benefit Rider Activation Form - OL5482

Give Nassau authority to share policy information with another party and submit it to the Nassau Service Center. Visit Service Forms and enter a policy/contract number to download the appropriate form.

Form number reference: Disclosure Authorization for Release of Policy/Contract Information - HO5074A

Update the address we have on file with your policy. When filling out the form, be sure to include the name of annuitant or insured and the contract/policy number. Choose whether you are changing the address for the owner, annuitant, insured, assignee, or a recipient of a duplicate notice. Provide the name and contact information of the policy owner.
This form requires the signature of the owner and joint owner (if any). Submit it to the Nassau Service Center.
Visit Service Forms and enter a policy/contract number to download the appropriate form.

Note: For certain policies/contracts, owners can access their account online and request an address change. This is available for owners only and requires registration/log in at nfg.com.

Form number reference: Address Change - OL4016

Update the account used for direct deposits sent to owner(s) of the policy/contract. Visit Service Forms and enter a policy/contract number to download the appropriate form and submit it to the Nassau Service Center.

Change Direct Deposit - OL4020

Certify the existence of a trust, as well as current trustees and/or successors. Visit Service Forms and enter a policy/contract number to download the appropriate form and submit it to the Nassau Service Center.

Form number reference: Certification and Acknowledgement of Trust Agreement - OL4132A

Update the name we have on file with your policy. Visit Service Forms and enter a policy/contract number to download the appropriate form and submit it to the Nassau Service Center.

Form number reference: Name Change - OL3135

Designate individual(s) as new owner(s). Visit Service Forms and enter a policy/contract number to download the appropriate form and submit it to the Nassau Service Center.

Form number reference: Ownership Change to Individual(s) - OL2346A

Designate a Non-Individual as new owner. Visit Service Forms and enter a policy/contract number to download the appropriate form and submit it to the Nassau Service Center.

Form number reference: Ownership Change to Non-Individual(s) - OL2346C

Designate a trust as new owner. Visit Service Forms and enter a policy/contract number to download the appropriate form and submit it to the Nassau Service Center.

Form number reference: Ownership Change to a Trust - OL2346E

Note: The Certification and Acknowledgment of Trust form must also be completed and submitted.

Change the beneficiary designation on any life or annuity policies. Visit Service Forms and enter a policy/contract number to download the appropriate form and submit it to the Nassau Service Center.

Form number reference: Beneficiary Designation - OL122A