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    Type of Existing Policy:: Surrendering Company Information

    Uploaded by

    Ejiro
    This document provides instructions for exchanging an existing life insurance policy for a new policy through an Internal Revenue Code Section 1035 exchange. Key details include: 1. The policy owner and insured must match between the existing and new policies. Joint policy owners are not allowed. Term policies do not qualify. 2. Information about the existing policy, including the surrendering company, policy number, insured and owner names, and policy type is provided. 3. The existing policy is being assigned to the new insurer in exchange for a new policy. The new policy will have the same owner and insured designations. The new insurer assumes no tax liability. 4. Signatures are required from the policy owner, agent

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Type of Existing Policy:: Surrendering Company Information

    Uploaded by

    Ejiro
    146 views1 page
    This document provides instructions for exchanging an existing life insurance policy for a new policy through an Internal Revenue Code Section 1035 exchange. Key details include: 1. The policy owner and insured must match between the existing and new policies. Joint policy owners are not allowed. Term policies do not qualify. 2. Information about the existing policy, including the surrendering company, policy number, insured and owner names, and policy type is provided. 3. The existing policy is being assigned to the new insurer in exchange for a new policy. The new policy will have the same owner and insured designations. The new insurer assumes no tax liability. 4. Signatures are required from the policy owner, agent

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    1035Barbara_Carmela copy.pdf

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    This document provides instructions for exchanging an existing life insurance policy for a new policy through an Internal Revenue Code Section 1035 exchange. Key details include: 1. The policy owner and insured must match between the existing and new policies. Joint policy owners are not allowed. Term policies do not qualify. 2. Information about the existing policy, including the surrendering company, policy number, insured and owner names, and policy type is provided. 3. The existing policy is being assigned to the new insurer in exchange for a new policy. The new policy will have the same owner and insured designations. The new insurer assumes no tax liability. 4. Signatures are required from the policy owner, agent

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    146 views1 page

    Type of Existing Policy:: Surrendering Company Information

    Uploaded by

    Ejiro
    This document provides instructions for exchanging an existing life insurance policy for a new policy through an Internal Revenue Code Section 1035 exchange. Key details include: 1. The policy owner and insured must match between the existing and new policies. Joint policy owners are not allowed. Term policies do not qualify. 2. Information about the existing policy, including the surrendering company, policy number, insured and owner names, and policy type is provided. 3. The existing policy is being assigned to the new insurer in exchange for a new policy. The new policy will have the same owner and insured designations. The new insurer assumes no tax liability. 4. Signatures are required from the policy owner, agent

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Instructions: LIFE

    A. Please type or print.


    B: Policy owner and policy insured must match between companies.
    C: No Joint policy owners.
    D: Term Policies do not qualify.
    E: Some companies may have different requirements and/or a special transfer form.
    Please check with the distributing company to verify of any addt’l requirements.

    IRC SECTION 1035 EXCHANGE FOR LIFE INSURANCE


    SURRENDERING COMPANY INFORMATION
    Farmer’s Insurance 009546289V
    __________________________________________________________ ______________________________________________________________
    Name of Existing Company Policy Number
    30801 Agoura Road, Bldg 1 Agoura Hills CA 91301-2054
    ______________________________________________________________________________________________________________________________________
    Address of Company City State Zip Code
    Carmela D. R. Betita Al-Nagdawi
    ______________________________________________________________________________________________________________________________________
    Name of Insured on existing policy (Please Print)
    Barbara J Betita Antonio 616 60 6626
    __________________________________________________________ _______-______-_______
    Name of Policy Owner on existing policy Policy Owner SS#

    TYPE OF EXISTING POLICY:


    ! Whole Life ! Universal Life ! Modified Endowment ! Term Policy

    6600539932
    ABSOLUTE ASSIGNMENT Policy Number: _________________________________
    The above listed policy has been assigned to the Insured selected above (the "Company) In exchange for the policy to be issued by
    the company. It is intended that this will qualify as a tax-free exchange within the provisions of the Internal Revenue Code, Section
    1035. Consequently, the policy issued by the Company will have the same Insured/Owner designations as the policy issued by the existing
    company. The Company assumes no responsibility or liability for the tax treatment under Internal Revenue Code Section 1035.

    If your policy has an outstanding loan prior to the exchange, the Company will not issue a new policy with an outstanding loan. The Company
    will, however, process a 1035 Exchange on a policy transferring the net cash value (cash value less any loans). However, any policy loan that
    exists prior to the exchange, is discharged. This constitutes the receipt of income which is taxable, and subject to gain, to the extent of the
    loan (Reg.1.103(b)-1(c).

    ! If there is an existing policy loan, which would result in taxable income, please do not proceed with the surrender. Please advise us of
    the amount of the loan and the amount of taxable income.

    ! If there is an outstanding loan which would result in taxable income, please proceed with the surrender.

    POLICY STATEMENT TAX


    ! My policy/contract is attached ! Please withhold Federal Income Tax
    ! My policy/contract is lost ! Please DO NOT withhold Federal Income Tax

    The undersigned hereby assign and transfer/surrender all right, title and interest in the above policy to the Company P.O.Box. Please make
    the check payable to the insurer selected below.

    Transamerica Life
    Federal Tax ID# 43-1162657 P.O.Box 5068 # # -
    Clearwater, Fl 33758-5068 P .O.Box 5068
    Clearwater , Fl 33758-5068

    SIGNATURES
    __________________________________________________________ ______________________________________________________________
    Policyowner(s) Signature Signature of Spouse (Community Property State)

    10/12/2018
    __________________________________________________________ ______________________________________________________________
    Agent Signature Date

    Jessica Ralleca, 59MEP


    __________________________________________________________ ______________________________________________________________
    Agent Name and Number (Please Print) Signature of Witness

    ______________________________________________________________________________________________________________________________________
    Accepting Signature of Company Officer Title Date

    I agree that a photocopy of this 1035 Exchange Agreement and Assignment shall be as valid as the original.

    NB00010- NF

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