NSS Forms and Resources

The National Slovak Society of the United States | Fraternal Life Insurance Since 1890

Annuity Resources

NSS Life annuity applications must be viewed with a program called Adobe Acrobat Reader. If you aren’t sure that you have it, you may download it for free from the Adobe website. Using an iPhone? Please download the app using the iStore. If you are on an Android device, download the app via the apps store.

To download the correct form, please choose the state in which the applicant resides – we are only licensed to sell to residents of: AL, AZ, CA, CO, CT, FL, GA, IL, IN, KY, MD, MI, MN, MO, NJ, NC, OH, PA, SC, TN, TX, VA, WV, and WI.

Direct State Download
(Click on a state name to download the application)
*Currently no new business being accepted

Annuity Form Download
(Click on a form name to download the form)
Note: There is a new Insurance Agent (Producer) Disclosure for Annuities form that will need to be filled out going forward for compliance purposes.

Agent Reference Guide

Agent of Record Change

Agreement for Exchange of Policies (1035)

Annuity Products Disclosure

Annuity Suitability Questionaire

Authorization to Transfer Funds

Bank Draft Authorization

Coverdell Education Savings Account

Death Claim - Annuity (IRA)

Death Claim - Annuity (Non-Qualified)

Direct Deposit Authorization - General

Full or Partial Annuity Withdrawal & W-4R

Insurance Agent Disclosure for Annuities

Investment Growth Fund Withdrawal

IRA Minimum Distribution Withdrawal & W-4R

IRA Qualified Charitable Distribution

IRA Successor Beneficiary Form for Traditional, Roth and Simple IRAs

IRA Successor Beneficiary Form for Traditional, Roth and Simple IRAs (2019 & Prior)

Monthly Bank Draft

Non-Qualified Successor Beneficiary

Qualified “Best Interest” Statement (PTE 84-24)

Replacement of Annuities - Internal

Replacement of Annuities - External

Request Affidavit for Lost Policy by the Owner

Non-Individual Ownership for Non-Qualified Annuities

Request for Beneficiary Change

Request for Service: Name/Address Change, etc.

Restricted Beneficiary - Qualified (Primary)

Restricted Beneficiary - Non-Qualified (Primary)

Restricted Beneficiary - Qualified (Contingent)

Restricted Beneficiary - Non-Qualified (Contingent)

Single Premium Immediate Annuity (SPIA)

Form W-4R

What is an Annuity?

A brief explanation of how an annuity works.

Have More Questions?

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Life Insurance Resources

NSS Life insurance applications and forms must be viewed with a program called Adobe Acrobat Reader. If you aren’t sure that you have it, you may download it for free from the Adobe website. Using an iPhone? Please download the app using the iStore. If you are on an Android device, download the app via the apps store.

To download the correct form, please choose the state in which the applicant resides – we are only licensed to sell to residents of: AL, AZ, CA, CO, CT, FL, GA, IL, IN, KY, MD, MI, MN, NJ, NC, OH, PA, SC, TN, TX, VA, WV, and WI.

State	FULL APPLICATION (AGES 60 & OLDER OR OVER $50,000)	SHORT APPLICATION (UP TO $50,000)	YOUTH TERM APPLICATION (UP TO $10,000)
Alabama
Arizona
California
Colorado
Connecticut
Florida*
Georgia
Illinois
Indiana
Kentucky
Maryland
Michigan
Minnesota
Missouri
New Jersey
North Carolina
Ohio
Pennsylvania
South Carolina
Tennessee
Texas
Virginia
West Virginia
Wisconsin