aviva assignment form

Protecting savings in turbulent times. Creating lifetime income for a secure retirement. At Athene, we’re always reaching higher so you retire better.

How do you picture retirement? Knowing what you’re working toward can help you and your financial professional create a financial plan to help you achieve your goals.

Athene Holding Ltd. (Athene) is a leading retirement services company that issues, reinsures, and acquires retirement savings products.

It's a great time for you to join one of the leading retirement services companies. Become a Game Changer and help more people make their next life their best life.

Athene USA 7700 Mills Civic Parkway West Des Moines, IA 50266

Call: 888-ANNUITY ( 888-266-8489 ) 8:00 a.m. - 5:00 p.m. CT, Monday - Friday

Fax: 866-709-3922

Service Forms

Need to change your beneficiary? File a claim? Request a withdrawal? All of the forms you may need are just a few questions away. 

First, we need to find out more about your product...

What type of contract or policy do you have, what is the name of the issuing company listed on your contract or policy, what type of life policy do you have, what was the original issuing company of your policy, does your contract number begin with ny1 or 66, does your contract begin with:, what was the original issuing company name, why the questions.

Because we've grown through the acquisition of multiple companies, with separate support teams.

Can't find the form you're looking for?

Call 888-ANNUITY ( 888-266-8489 ) and we'll be happy to help you.

  Your results...

Call 855-615-2276 to speak to an Alliance-One customer service representative.

Your results...

Call 877-462-8992 to speak to an Alliance-One customer service representative.

Administrative Forms

• Address Change Request
• Name Change Request
• Electronic Funds Transfer Fund
• Authorization to Release Information
• Pension Plan Verification

Policy Change Forms

• Beneficiary Change Request
• Additional Beneficiaries Designation- Supplement to Beneficiary Change
• Trust Verification Form
• Request for Service Form
• Change of Ownership Form
• Income Benefit Rider Election and Service Request Form - TargetPay and TargetPay Plus

Withdrawal Request Forms

• Required Minimum Distribution (RMD) Request
• Systematic Withdrawal Form
• Withdrawal Request
• Withdrawal Request - Tax Sheltered Annuity (TSA)
• Qualified Charitable Distribution (QCD)
• Income Rider Withdrawal Request for BPA Income
• Income Rider Withdrawal Request for Fixed Products
• Income Rider Withdrawal Request for Indexed Products
• Income Rider Withdrawal Request for LifeTime Solutions Annuity
• Terminal Illness Withdrawal Packet
• Confinement Withdrawal Packet
• W-9 Taxpayer ID Form

Buyer's Guides

• Annuity Buyer's Guide
• Annuity Buyer's Guide - KY
• Annuity Buyer's Guide - WI

Claim Forms

• Annuity Claim Form Statement of Beneficiary  - for beneficiaries of contracts in a payout/settlement status
• Life Claim Form  - for beneficiaries of American Investors Life policies
• Individual Beneficiary Qualified Claims Form Kit
• Entity Beneficiary Claims Form Kit
• Individual Beneficiary Non-Qualified Claims Form Kit
• Trust Beneficiary Claims Form Kit
• Estate Beneficiary Claims Form Kit

Call 888-266-8489 to speak to a customer service representative.

• Electronic Funds Transfer (EFT) Authorization
• Address Change Form
• Name Change Form
• Power of Attorney Affidavit
• Authorization to Release Policy Information
• Verification of Trust

Policy Change Form

• Beneficiary Change Form
• Ownership Change Form
• Collateral Assignment of Life Insurance or Non-Qualified Annuity Form
• Transfer of Collateral Assignment
• Collateral Assignment Release
• Request for Policy Change
• Request for Policy Change Flexible Premium Universal Life
• Request to Convert – Term Policy to Whole Life
• Request to Change to Extended Term or Reduced Paid Up

Withdrawal Forms

• Request for Full/Partial Surrender - Life Insurance
• Life Loan Agreement
• Request for Distribution of Life Insurance Maturity Proceeds
• Athene Annuity & Life Assurance Company of New York Appendix 10A (Alternate 1)
• Athene Annuity & Life Assurance Company of New York Appendix 10C (Alternate 1)
• Athene Annuity & Life Assurance Company of New York Appendix 11 (Alternate 1)

Call 800-866-9933 to speak to a Protective Life Insurance customer service representative.

• Authorize an Electronic Funds Transfer EFT
• Authorize to release policy information
• Electronic Funds Deposit Authorization
• Request a duplicate policy certificate
• Affidavit of Power of Attorney
• Change of Annuitant Form
• Owner Change Form
• Assign my policy and I live in Louisiana
• Collateral Assignment Release Form
• Collateral Assignment Form
• Transfer of Collateral Assignment Form
• Change of Payee
• Co-Owner Change Form
• Pension Plan Verification Form
• Company, Partnership or LLC Verification Form
• Divorce Affidavit Form
• Annuitize my contract
• Authorize automatic withdrawals from my annuity contract
• Make a partial withdrawal from my annuity contract
• Surrender my annuity contract
• Request a required minimum distribution
• Make a partial withdrawal from my TSA/403b contract
• Surrender my TSA/403b contract
• Substantially Equal Periodic Payments under 72q & 72t

Transfer/Rollover Forms

• Convert my existing traditional IRA to a Roth IRA
• Transfer funds from Employee Retirement Plan
• Traditional-IRA to Roth-IRA Conversion
• 1035 Exchange/Absolute Assignment
• Authorize to Release Policy Information
• Withdrawal and Surrender Request – Annuity Contracts Only
• Withdrawal, Surrender and RMD -Pension Plan (does not include 403(b)/TSA)
• Systematic Withdrawal Request
• Substantially Equal Periodic Payments under 72q and 72t
• TSA Withdrawal and Surrender Request
• TSA Loan Request
• Annuitize My Contract
• IRA Qualified Charitable Distribution Request
• Withholding Election Change Form
• Change your existing 403(b)/TSA to a Traditional IRA
• Change your existing Traditional IRA to a SEP-IRA
• Change your existing Pension, Money Purchase, or Profit Sharing Plan to a Traditional IRA
• Change your existing SEP-IRA to a Traditional IRA
• Change your existing 401(k) to a Traditional IRA
• Convert your existing Traditional IRA to a Roth IRA
• Authorize an Electronic Funds Transfer (EFT)
• Affidavit of Attorney-in-Fact

Policy Change and Disbursement Forms

• Variable Universal Life Service Request Form
• Clarity Variable Annuity Service Request Form
• Clarity 2+2 Variable Annuity Service request Form
• Change of Payee Form
• Variable Annuity Disbursement Request Form
• Make an IRA Qualified Charitable Distribution
• Withdrawal and Surrender Request- Annuity Contracts Only
• Withdrawal, Surrender and RMD - Pension Plan (does not include 403(b)/TSA)
• Request withdrawal under Terminal Illness/Confinement Waiver
• Benefit 10 – Request withdrawal under Terminal Illness/Confinement
• Annuity Systematic Withdrawal Request
• Request to Begin, Suspend or Restart Income Rider Payments; Request to Terminate Income Rider
• Benefit 10 – Request to Begin, Suspend or Restart Income Rider Payments; Request to Terminate Income Rider
• Request to Rollover
• Request to Transfer Traditional IRA to SEP-IRA
• Request to Transfer SEP-IRA to Traditional IRA
• Request to Transfer
• Collateral Assignment
• Transfer of Collateral Release Form
• Required Minimum Distribution (RMD) Form
• TSA Loan Repayment Distribution Form
• Policy Change Flexible Premium Universal Life
• Authorization to Release Information
• Pension Plan Varification Form
• Required Minimum Distribution Package
• Annuity Substantially Equal Periodic Payments Under I.R.C. Sections 72(Q) and 72(T)
• Partial Withdrawal / Full Surrender Request
• Annuity Systematic Withdrawal Form
• Settlement Option Election Form
• Withdrawal and Surrender Request - Corporate Pension
• Athene Annuity & Life Assurance Company of New York Appendix 10B (Alternate 1)
• Athene Annuity & Life Assurance Company of New York Appendix 10C (Alternate 1)
• Request Partial Withdrawal or Full Surrender under Confinement Waiver or Terminal Illness Waiver
• Benefit 10- Request for Withdrawal under Terminal Illness or Confinement Provision
• Internal Traditional IRA to Roth IRA Conversion
• Request to Transfer Qualified Plan to Qualified Plan
• Request to Rollover 403(b) TSA to Traditional IRA
• Election of Withholding

Call 800-366-5463 to speak to a LifeCare Assurance Company customer service representative.

For claim forms, call 800-800-9882 to speak with a customer service representative.

Contact Information

Mailing Address: P.O. Box 1555 Des Moines, IA 50306-1555

Fax Number: 800-531-0038

Phone Number: 800-800-9882

Fax Number: 866-709-3922

Phone Number: 888-266-8489

For claim forms, call 800-926-7599 to speak with a customer service representative.

Mailing Address: PO Box 64269 St. Paul, MN 55164-0269

Fax Number: 855-893-5663

Phone Number: 800-926-7599

For claim forms, call 800-234-5514 to speak with a customer service representative.

Mailing Address:

PO Box 64294 St. Paul, MN 55164-0294

Fax Number: 866-860-4024

Phone Number: 800-234-5514

For claim forms, call 800-423-9398 to speak with a customer service representative.

​​​​​​​PO Box 64296 St. Paul, MN 55164-0296

Phone Number: 800-423-9398

For claim forms, call 866-690-1992 to speak with a customer service representative.

Mailing Address: PO Box 725449 Atlanta, GA 31139

Fax Number: 770-690-1985

Phone Number: 866-690-1992

Mailing Address: ​​​​​​​

PO Box 64285 St. Paul, MN 55164-0285

Fax Number: 855-471-3817

Phone Number: 866-626-1161

For claim forms, call 866-626-1161 to speak with a customer service representative.

PO Box 64279 St. Paul, MN 55164-0279

Fax Number: 855-893-5662

Annuities contain features, exclusions, limitations and availability that may vary by state and/or sales distributor.   For a full explanation of an annuity, please refer to the Certificate of Disclosure or Prospectus (as applicable) and contact your financial professional or the company for costs and complete details. This material is a general description intended for general public use. 

Annuity contracts and group annuity contracts are issued by Athene Annuity and Life Company (61689), West Des Moines, IA, in all states (except New York), and in D.C. and P.R. Annuity contracts are issued by Athene Annuity & Life Assurance Company of New York (68039), Pearl River, NY, in New York. Group annuity contracts for New York residents and New York contract holders are issued in New York by Athene Annuity & Life Assurance Company of New York, Pearl River, NY. Payment obligations and guarantees are subject to the financial strength and claims-paying ability of the issuing insurance company. Insurance products may not be available in all states. These companies are not undertaking to provide investment advice for any individual or in any individual situation, and therefore nothing in this should be read as investment advice. This material should not be interpreted as a recommendation by Athene Annuity and Life Company, Athene Annuity & Life Assurance Company of New York, or Athene Securities, LLC. Please reach out to your financial professional if you have any questions about insurance products and their features. 

The term “financial professional” is not intended to imply engagement in an advisory business with compensation unrelated to sales. Financial professionals will be paid a commission on the sale of an annuity.

INVESTMENT AND INSURANCE PRODUCTS ARE: • NOT FDIC INSURED • NOT INSURED BY ANY FEDERAL GOVERNMENT AGENCY • NOT A DEPOSIT OR OTHER OBLIGATION OF, OR GUARANTEED BY, THE BANK OR ANY OF ITS AFFILIATES • SUBJECT TO INVESTMENT RISKS, INCLUDING POSSIBLE LOSS OF THE PRINCIPAL AMOUNT INVESTED

Reinsurance contracts are entered into with Athene Annuity and Life Company (61689), West Des Moines, IA; Athene Annuity & Life Assurance Company (61492), Wilmington, Delaware; Athene Annuity & Life Assurance Company of New York (68039), Pearl River, NY; Athene Life Re Ltd., Hamilton, Bermuda; and Athene Annuity Re Ltd., Hamilton, Bermuda. Not all reinsurance products or structures offered are available in all jurisdictions. Reinsurers may not be licensed in all states. All transactions are subject to meeting a reinsurer’s underwriting requirements. Reinsurance products are not protected or guaranteed by state insurance guaranty associations or insolvency funds. 

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