Withdraw from a Qualified Annuity Contract

Surrender or withdraw funds from a qualified annuity contract.

Instructions

Complete Form

Complete the Request for Disbursement form for all qualified annuity policies. Fill out all relevant sections on the form as all incomplete forms will be returned. This includes the tax withholding section on page 4 on form ADMIN5588 and page 3 on form ADMIN5587.

Type of Surrender

Check the box for only one surrender type. The options are Partial Surrender or Full Surrender. If you are transferring to a traditional IRA to a Roth IRA, check the "Full Surrender" option along with the "Traditional IRA Transfer to Roth IRA" option. There are 4 options for partial surrenders: Maximum available partial, Maximum "penalty free" amount, interest only or a specific amount. Please only choose one option.

Signatures

If there are joint owners on the policy they must both sign the withdrawal request. If the policy is corporately owned the signatures of two officers and their titles must be provided. Request from a POA require that Fidelity & Guaranty Life Insurance Company have current, less than 6 months, POA documentation.

Submit form

Return the completed forms with any required documentation via U.S. mail, overnight mail or fax to Fidelity & Guaranty Life Insurance Company Service Center.

Postal Mail

Fidelity & Guaranty Life Insurance Company Service Center
P.O. Box 81497
Lincoln, NE 68501-1497

Overnight Mail

Fidelity & Guaranty Life Insurance Company Service Center
777 Research Drive
Lincoln, NE 68521

Fax

402-328-2266

Allow 15 days to process

Fidelity & Guaranty Life Insurance Company will process the request within 15 business days of receipt if in good order.

Payment

Unless noted otherwise a check will be mailed to the owner's address of record.

Featured Box Image

Request for Disbursement Form admin 5588

BACK
15-788

Still have questions?

Reach out to our customer service.