CONTRACT CHANGE REQUEST for Structured Settlement Annuities 05/12 [ISS CHANGE] W26136-11A When to use this form: Use this form to make beneficiary, address, telephone number and/or name changes to your annuity contract. To complete this form: Print clearly using dark ink. Provide requested information in full. To request a change of beneficiary, complete the information below and return this form to Pacific Life & Annuity Company for delivery to contract owner. Forms for use with annuity products. close. Annuities Annuities provide steady, reliable lifetime income and help grow, protect, and manage retirement savings. At Pacific Life, we offer a variety of annuities to fit your specific preferences and goals. REGISTERED REPRESENTATIVE AND BROKER/DEALER CHANGE REQUEST 10/15 [TRAN] *AE7853-15A* CONTACT INFORMATION CONTACT INFORMATION (for New York only) Pacific Life Insurance Company All Overnight Deliveries: Pacific Life & Annuity Company P.O. Box 2378 6750 Mercy Rd, 4th Floor, RSD P.O. Box 2829

That's because we've made some changes to our Annuities website to enhance your online experience. It's part of What is my contract number? Where can I 

withdrawals, beneficiary changes, fund transfers and maintenance. Contract Maintenance Download Form. Annuity Contract/Beneficiary Change Request. OWNER If trust is owner, also complete Trust Agreement Certification form. termination or change in value of any existing life insurance or annuity in this or any  Contract Maintenance Download Form. Annuity Contract/Beneficiary Change Request. W25065-16B. Disability Certification. E25067-15A. Electronic Funds  A fixed indexed annuity is a long-term contract that can help you meet your financial The Interest Enhanced Death Benefit, available with Pacific Life fixed indexed annuities for o Protect the amount of your purchase payment for your beneficiaries. A hypothetical 5% cap is used in this example and is subject to change.

o Enter each beneficiary's SSN, date of birth, address and phone numbers – it will If “Yes” to Question 10.a., list all existing life insurance policies and annuity contracts. I will review my policy and ask the producer or Pacific Life Insurance to annuitize, convert to an annuity, or otherwise change the form of the assets in 

Pacific Life is a product provider. It is not a fiduciary and therefore does not give advice or make recommendations regarding insurance or investment products. Pacific Life refers to Pacific Life Insurance Company and its affiliates, including Pacific Life & Annuity Company. Forms for use with life insurance products. Other Interested Party Authorization Request. Form #15-30276-03. This form may be used for a life insurance or fixed annuity policy to: authorize an interested party, request and receive policy information, remove an interested party, or stop/start duplicate mailings to an interested party. An annuity can help with those as well, because there are different types of annuities that can be tailored to what’s most meaningful to you. Have confidence in your financial future with the help of your financial professional and a Pacific Life annuity.

11 Mar 2015 a request by the Annuity Contract Owner, Beneficiary, annuitant, or legal representative thereof, to change the designation of a. Beneficiary 

Ownership. • Beneficiary. • Annuitant. Use form FR1208 to make a change to a contract with MassMutual Lifetime Income ProtectorSM or MassMutual Lifetime  Variable annuity contracts are not designed for frequent transfers either by individual MONY Life Insurance Company of America (the “Company”) issues the flexible Change in Operation of MONY America Variable Account A. 45 The Contract is also designed to allow the owner to request payments of part or all of the 

REGISTERED REPRESENTATIVE AND BROKER/DEALER CHANGE REQUEST 10/15 [TRAN] *AE7853-15A* CONTACT INFORMATION CONTACT INFORMATION (for New York only) Pacific Life Insurance Company All Overnight Deliveries: Pacific Life & Annuity Company P.O. Box 2378 6750 Mercy Rd, 4th Floor, RSD P.O. Box 2829

The Lincoln National Life Insurance Company. Lincoln Life & Annuity Company of New York. First Penn-Pacific Life Insurance Company. (as in your contract and   Ownership. • Beneficiary. • Annuitant. Use form FR1208 to make a change to a contract with MassMutual Lifetime Income ProtectorSM or MassMutual Lifetime  Variable annuity contracts are not designed for frequent transfers either by individual MONY Life Insurance Company of America (the “Company”) issues the flexible Change in Operation of MONY America Variable Account A. 45 The Contract is also designed to allow the owner to request payments of part or all of the  11 Mar 2015 a request by the Annuity Contract Owner, Beneficiary, annuitant, or legal representative thereof, to change the designation of a. Beneficiary 

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