Forms

Used by a client to authorize VALIC to transfer funds to a bank account as specified by the client. PDF only.

Used to select the type, annuity benefit, and payment frequency. Note- once selected, the annuity option is irrevocable. This form is used for POWER Index, and Assured Choice (available for Independent Channel Only)

Used to initiate the minimum distribution as required by the IRS. This form is used for POWER Index, and Assured Choice which is available in Independent Channel Only.

Used to request a direct Rollover of Funds to a new plan type from another Carrier to VALIC. This form is used for POWER Index, and Assured Choice available for Independent Channel. This form is also used for American Pathway Elite products within Forms Bundling.

Used to request a partial withdrawal and assignment of proceeds under section code 1035a. This form is used for POWER Index and Assured Choice - available for Independent Channel.

Used to transfer money into the same plan type for 1035 exchanges. This form is used for Assured Choice(available in Independent Channel Only), Power Index, and American Pathway Elite products.

Used to request an agreement or to change or cancel an existing agreement allowing for the preauthorized debit of systematic premiums. This form is used for POWER Index, and Assured Choice (available for Independent Channel Only)

Used to establish a systematic withdrawal of a designated amount and frequency. This form is used for POWER Index and Assured Choice (available in Independent Channel Only).

Used to request a partial or full cash withdrawal from an annuity contract other than 403(b). Thisa form is used for POWER Index, and Assured Choice (available in Independent Channel Only)

Used to request a partial or full cash withdrawal from a 403(b) plan only. This form is used for Assured Choice (available in Independent Channel Only)

Used to describe the forms needed to complete transactions involving External Broker Dealers selling VALIC products.

Use to provide additional information for distributions for - military reservists called to active duty, health, long-term care or accident insurance for retired public safety officers, or hardship or UEWs for certain beneficiaries of 457 plans

Used when a Power of Attorney related request is being made. This form is used with all VALIC products.

Used to request an internal Roth IRA conversion of an existing account for American Pathway Elite 4 and 7.

Used to make a withdrawal of funds from 457 plans for unforeseeable emergencies.

Used to initiate a Section 1035 Exchange In from an outside carrier to a VALIC account. Send forms directly to Home office for processing. Home office will obtain signoff on suitability from Regional Compliance Analyst.

Used to select a Payout option (payment frequency and method) when annuitizing a clients account.

Used to initiate distribution of a partial withdrawal, maximum withdrawal or full surrender.

Used by a beneficiary to claim proceeds from a participants account after death.

Used to request account combination (different group,plan,subgroup to one account) or internal rollover from one VALIC account to another. For product exchanges use VL9034. Minimum Distribution required prior to rollover if client has attained age 70.5.

Used for changes to an existing periodic payment associated with a Required Minimum Distribution (RMD) only.

Used to initiate the minimum distribution for group sponsored plans clients only as required by the IRS.

Used for RMD set ups for group sponsored plans only clients where VALIC calculated, pro-rata, multi-year automatic recurring payments. Use RMD Maintenance Form for making changes to an existing RMD. Use Beneficiary Distribution form for beneficiary distributions. Do not use this form for IRA plans.

Used for RMD set ups for IRA only clients where participant calculates RMD payment, prior year payments, non pro-rata fund selection, joint life expectancy calculation, reinvestment into an existing nonqualified deferred annuity. Use RMD Maintenance Form for making changes to an existing RMD. Use Beneficiary Distribution form for beneficiary distributions. Do not use this form for group sponsored plans.

Used for RMD set ups for IRA only clients where VALIC calculated, pro-rata, multi-year automatic recurring payments. Use RMD Maintenance Form for making changes to an existing RMD. Use Beneficiary Distribution form for beneficiary distributions. Do not use this form for group sponsored plans.

Used to assist clients in understanding Fixed and Fixed Index Annuities in the following states AL AK AR AZ CO FL GA HI IA ID KY ME MO MT NV NJ NM NC OH OK OR RI SC UT WI and WV. Also required in AL, CO, FL, GA, IA, ME, MO, NH, OH, RI, TX, WI, and WV for Variable Annuities. Must be provided to clients at time of application for the following plan types only IRA, Roth IRA, SEP, Simple IRA and NQDA. Use appropriate guide based on client's state of residence. New Hampshire requires the NAIC buyers guide effective 4/30/2018 with 60 day implementation extension period to 6/30/2018.

Used to provide additional fund selection space as an addendum to Application, Enrollment, Internal Combination or Rollover and Combined Enrollment or Exchange forms. PDF only.

Used when the client has an IRA account and wants to send distribution payments to a qualified 501(c)(3) organization that is eligible to receive tax deductible contributions. Must be used with another VALIC distribution form.

Used to transmit an additional contribution for a client and for providing the client with a receipt. Complete only as needed.

Used by the Independent Channel to transmit an additional contribution for a client and for providing the client with a receipt. Complete only as needed.

Used exclusively by external broker-dealers to liquidate Nonqualified or Non-Insurance accounts and transfer funds to VALIC.

Used to initiate distribution of a partial withdrawal, maximum withdrawal or full surrender.

Used to establish a systematic withdrawal of a designated amount, designated number of years or substantially equal payments. Version 10-2002 includes the Fixed Interest Only option feature and allows for fund selection. Use form VL 20795-LB if the account has a living benefit.

Used for accounts with living benefits to establish a systematic withdrawal of the MAWA or a designated amount less than tor equal to the MAWA. This form should only be used for accounts with living benefits. Use form VL 20795 if the account does not have a living benefit.

Used exclusively by external broker-dealers to transfer-rollover in funds for ALL PLAN TYPES from a client account at another carrier to VALIC.

Used to request withdrawal or distribution for funds for hardship reasons.

Used to submit an administrative change of ownership to a client account.

Used for the following (must be same ER group and Plan )-Roll existing VALIC assets to a designated Roth VALIC acct-Roll existing VALIC assets to a designated acct at another provider-Roll assets from another plan provider to a VALIC designated Roth acct.

Used with Premiere 5 and 7, Power Index and (Proflex Independent Channel only) products, to provide proof of extended care in order to waive the contracts early withdrawal charge.

Used with Power Index and (Proflex Independent Channel only) products, to provide proof of terminal illness in order to waive the contracts early withdrawal charge.

Transfer Rollover In

Description

Used exclusively by external broker-dealers to transfer-rollover in funds for ALL PLAN TYPES from a client account at another carrier to VALIC.

Inside Edge Fixed Annuity Application must accompany the Inside Edge custodial application. PDF includes Application, Owner Acknowledgement, Agent Access and Client Profile. Replaces VL 25459.

Inside Edge Fixed Annuity Application must accompany the Inside Edge custodial application. PDF includes Application, Owner Acknowledgement, Agent Access and Client Profile. Replaces VL 25459 for FLorida only.

Inside Edge Fixed Annuity Application must accompany the Inside Edge custodial application. PDF includes Application, Owner Acknowledgement, Agent Access and Client Profile. Replaces VL 25459 for New Jersey only.

Inside Edge Fixed Annuity Application must accompany the Inside Edge custodial application. PDF includes Application, Owner Acknowledgement, Agent Access and Client Profile.For use in New York only. Replaces VL 25459 NY only

Inside Edge Fixed Annuity Application must accompany the Inside Edge custodial application. PDF includes Application, Owner Acknowledgement, Agent Access and Client Profile. Replaces VL 25459-VA.

VALIC Fixed Annuity-406 application. PDF includes Application, Owner Acknowledgement, Agent Access and Client Profile. Replaces VL 25459 (406).

VALIC Fixed Annuity-406 application. For use in Florida only. PDF includes Application, Owner Acknowledgement, Agent Access and Client Profile. Replaces VL 25459(406) in Florida Only

VALIC Fixed Annuity-406 application. PDF includes Application, Owner Acknowledgement, Agent Access and Client Profile. Replaces VL 25459(406) in New Jersey.

VALIC Fixed Annuity-406 Allocation. For use in New York only. PDF includes Application, Owner Acknowledgement, Agent Access and Client Profile. Replaces VL 25459 NY only (406)

VALIC Fixed Annuity-406 Allocation. For use in Virginia only. PDF includes Application, Owner Acknowledgement, Agent Access and Client Profile. Replaces VL 25459-VA (406).

Used when enrolling clients in Group or Individual Annuity products in the state of New York - informing the client regarding VALICs policy of compensating its insurance producers and their role in offering insurance products. Independent Channel.

Inside Edge Mutual Fund Employee enrollment form for IRA enrollment.

SEE REPLACEMENT TAB

See Replacement Tab for access to State Replacement Forms.

Required for all VALIC annuity products (fixed, variable, qualified and nonqualified ) being sold to clients who reside in CA and are 65 years of age or older if the product is being sold on the basis of its treatment under the CA Medi-Cal program.

Used when replacing life insurance products, including annuities and with all new business in the following states. AL-AR-AK-AZ-CO-CT-HI-IA-KY-LA-MD-ME-MO-MS-MT-NC-NE-NH-NJ-NM-OH-OR-RI-SC-SD-TX-UT-VT-WI-WV. Replacement

This disclosure form is required if the client has answered YES to being an active duty service member of the United States Armed Forces for all individual non-qualified and IRA applications.

Used to grant account access to Agents as named by the client or to establish a Contact Center password on the clients account. PDF only.

Used to submit beneficiary designations changes for Profile or Inside Edge Accounts only.

Required to establish Investment Advisory Services on a VALIC client account(s).

Used to open an IRA-Roth IRA in the name of a Minor. Affiant agrees to indemnify VALIC, including its agents, employees, successors, and assigns from every claim, demand or suit brought against them.

Used to establish Independent Channel accounts. Must be completed and submitted with every application, VALIC transfer, rollover, exchange, except VALIC group enrollments in a variable product. Distribute form copies as noted in the legend at bottom.

Used to authorize a reduction or termination of a salary reduction agreement for Traditional and Roth IRAs.

Used exclusively by external broker-dealers to liquidate Nonqualified or Non-Insurance accounts and transfer funds to VALIC.

Used by the Independent Channel to transmit an additional contribution for a client and for providing the client with a receipt. Complete only as needed.

Required for all Florida transactions when purchasing a fixed annuity product regardless of how it is funded. Signature pages must be signed. Replaces VL 22982-A

Required for all Florida transactions when purchasing an annuity product and the source of the money is another annuity. Signature pages must be signed. replaces VL 22982-B

Used when replacing life insurance products, including annuities and with all new business in Virginia.

Used to assist clients in understanding Fixed and Fixed Index Annuities in the following states AL AK AR AZ CO FL GA HI IA ID KY ME MO MT NV NJ NM NC OH OK OR RI SC UT WI and WV. Also required in AL, CO, FL, GA, IA, ME, MO, NH, OH, RI, TX, WI, and WV for Variable Annuities. Must be provided to clients at time of application for the following plan types only IRA, Roth IRA, SEP, Simple IRA and NQDA. Use appropriate guide based on client's state of residence. New Hampshire requires the NAIC buyers guide effective 4/30/2018 with 60 day implementation extension period to 6/30/2018.

Used in the state of Kentucky to assist clients in determining their insurance needs and the products related. Must be provided to the client.

Inside Edge Mutual Fund Employee Enrollment form for 401(a) enrollment.

Used to authorize a reduction of salary to fund a Section 403(b) plan. SRA

Used to authorize a reduction of salary to fund a Section 403(b) plan with ROTH deferral available.

Used to authorize a salary reduction and deferral of compensation for groups offering both plans to employees with ROTH deferral available.

Used to authorize a salary reduction and deferral of compensation for groups offering both plans to employees. Plan must offer both plans to use this form.

Inside Edge Mutual Fund Employee enrollment form for 403(b) enrollment.

Inside Edge Mutual Fund Inidividual 403(b) Custodial Account Agreement. This document must be provided to individual at application.

Used to authorize a deferral of salary to fund a 401(k) plan.

Used to authorize a deferral of salary to fund a 401(k) plan with ROTH deferral available.

Inside Edge Mutual Fund Employee enrollment form for 403(b) enrollment for use in Texas only.

Used for a client to defer compensation pursuant to the Employees Deferred Compensation Plan.

Used for a client to defer compensation of a 457(b) Governmental plan pursuant to the Employees Deferred Compensation Plan.

Inside Edge Mutual Fund Individual 457(b) Custodial Account Agreement. This document must be provided to individuals at application.

Inside Edge Mutual Fund Employee Enrollment form for 457(b) enrollment.

Inside Edge Mutual Fund Employee Enrollment form for 457(b)Enrollment for use in Texas only.

Inside Edge Fixed Annuity Application must accompany the Inside Edge custodial application. PDF includes Application, Owner Acknowledgement, Agent Access and Client Profile. Replaces VL 25459.

Inside Edge Fixed Annuity Application must accompany the Inside Edge custodial application. PDF includes Application, Owner Acknowledgement, Agent Access and Client Profile. Replaces VL 25459 for New Jersey only.

Inside Edge Fixed Annuity Application must accompany the Inside Edge custodial application. PDF includes Application, Owner Acknowledgement, Agent Access and Client Profile. Replaces VL 25459 for FLorida only.

Used to authorize a salary reduction and deferral of compensation for groups offering both plans to employees. Plan must offer both plans to use this form.

Used to authorize a salary reduction and deferral of compensation for groups offering both plans to employees with ROTH deferral available.

Inside Edge Mutual Fund Individual 457(b) Custodial Account Agreement. This document must be provided to individuals at application.

Proflex FLEXPDFA will close for new applications - sales in all states. The product will remain open for certain groups in IL and KS until a replacement product can be determined. Replaces VL 25456

Used to establish electronic fund transfers for IRAs, non qual tax deferred annuities (NQDAs) SEPs.

Used to authorize a salary reduction and deferral of compensation for groups offering both plans to employees. Plan must offer both plans to use this form.

Used to authorize a salary reduction and deferral of compensation for groups offering both plans to employees with ROTH deferral available.

Used to provide additional fund selection space as an addendum to Application, Enrollment, Internal Combination or Rollover and Combined Enrollment or Exchange forms. PDF only.

Used to authorize salary reductions for SIMPLE 401(k) plans. PDF only. You are responsible for distributing copies as noted in the distribution legend at the bottom of the form.

Required by the Texas Retirement System. This form must accompany any new K-12 403(b) applications for a Series 1 contract. For Independent Channel use only.

Required by the Texas Retirement System. This form must accompany any new K-12 403(b) applications for a Series 5 contract. For Independent Channel use only.

Used to submit additional beneficiary designations that exceed space allotted on VL 14945 or application forms. Must submit with VL 14945 or application form. PDF only.

Used only in Florida when replacing life insurance products including annuities funded through values in existing enforce policy with same insurer Instructions on cover page Obtain submit replacement form to expedite processing by redeeming carrier.

Salary Reduction Agreement for SIMPLE IRA plans. PDF only. You are responsible for distributing copies as noted in the distribution legend at the bottom of the form.

Used exclusively in New York by Independent Channel Broker-Dealers when replacing an individual annuity or other insurance products. Instructions for distribution of copies and materials are on the cover page of the form. Replacement. PDF includes VL 19176 Authorization To Disclose Information - NY Reg 60

Used exclusively in Ney York by Independent Channel Broker Dealers when replacing an individual annuity or other insurance products. Instructions for distribution of copies and materials are on the cover page of the form. Replacement.

Used exclusively in New York by the Independent Channel Broker Dealer when replacing an individual annuity or other insurance products. Instructions for distribution of copies and materials are on the cover page of the form. Replacement.

Used exclusively in NY when replacing an individual annuity or othr insurance products to authorize current carrier to release information necessary to complete attached forms pursuant to NY Reg 60. Replacement. PDF includes VL 12667-IC NY Replacement Form for New York - NY 10A

Used by Independent Channel to enroll participants in a qualified GROUP contract. Use state specific for FL, NJ, NY and VA. PDF includes Application and Agent Access. The OA is required in all states. Replaces VL 26443.

Used by Independent Channel to enroll in a qualified GROUP contract in Florida. Use state specific for NJ, NY and VA. PDF includes Application and Agent Access. The OA is required. Replaces VL 26443-FL.

Used by Independent Channel to enroll participants in a qualified GROUP contract in New Jersey. PDF includes Application and Agent Access. Replaces VL 26443-NJ

Used exclusively by Independent Channel in New York State only to enroll participants in a qualified GROUP contract. Enrollment. PDF includes Owner Acknowledgement and Agent Access forms. Replaces VL 26443-NY

Used by Independent Channel to enroll in a qualified GROUP contract in Virginia. PDF includes Application and Agent Access. Replaces VL 26443-VA.

Replacement

Used in Arkansas for all Individual and Group Annuity contracts when replacing an Individual Fixed Deferred Annuity. Replacement Memorandum must be completed at the point of sale.

Used when replacing life insurance products, including annuities and with all new business in the following states. AL-AR-AK-AZ-CO-CT-HI-IA-KY-LA-MD-ME-MO-MS-MT-NC-NE-NH-NJ-NM-OH-OR-RI-SC-SD-TX-UT-VT-WI-WV. Replacement

Used exclusively in New York by the Independent Channel Broker Dealer when replacing an individual annuity or other insurance products. Instructions for distribution of copies and materials are on the cover page of the form. Replacement.

Used only in Florida when replacing life insurance products including annuities funded through values in existing enforce policy with same insurer Instructions on cover page Obtain submit replacement form to expedite processing by redeeming carrier.

Used exclusively in California when replacing life insurance products, including annuities. Instructions are on the cover page. Obtain submit replacement form to expedite processing by redeeming carrier.

Used exclusively in Delaware when replacing life insurance products, including annuities. Instructions are on the cover page. Obtain submit replacement form to expedite processing by redeeming carrier.

Used exclusively in Idaho when replacing life insurance products, including annuities. Instructions are on the cover page. Obtain and submit replacement form to expedite processing by redeeming carrier.

Used exclusively in Illinois, when replacing life insurance products, including annuities. Instructions are on the cover page. Obtain and submit replacement form to expedite processing by redeeming carrier.

Used exclusively in Indiana when replacing life insurance products, including annuities. Instructions are on the cover page. Obtain submit replacement form to expedite processing by redeeming carrier.

Used exclusively in Kansas when replacing life insurance products, including annuities. Instructions are on the cover page. Obtain submit replacement form to expedite processing by redeeming carrier.

Used exclusively in Massachusetts when replacing life insurance products, including annuities. Instructions are on the cover page. Obtain and submit replacement form to expedite processing by redeeming carrier.

Used exclusively in Minnesota when replacing life insurance products, including annuities. Instructions are on the cover page. Obtain submit replacement form to expedite processing by redeeming carrier.

Used exclusively in Nevada when replacing life insurance products and annuities (other than individual fixed deferred annuities). Instructions on the cover page. Obtain and submit replacement form to expedite processing by redeeming carrier.

Used exclusively in Nevada when replacing life insurance products, including annuities. Instructions on the cover page. Submit replacement form to expedite processing by redeeming carrier. Include VL 14715-A when replacing a fixed annuity. Replacement.

Used exclusively in New York by Independent Channel Broker-Dealers when replacing an individual annuity or other insurance products. Instructions for distribution of copies and materials are on the cover page of the form. Replacement. PDF includes VL 19176 Authorization To Disclose Information - NY Reg 60

Used exclusively in Ney York by Independent Channel Broker Dealers when replacing an individual annuity or other insurance products. Instructions for distribution of copies and materials are on the cover page of the form. Replacement.

Used exclusively in Oklahoma when replacing life insurance products, including annuities. Instructions are on the cover page. Obtain and submit replacement form to expedite processing by redeeming carrier.

Used exclusively in Pennsylvania when replacing life insurance products, including annuities. Instructions are on the cover page. Obtain submit replacement form to expedite processing by redeeming carrier.

Used exclusively in Tennessee when replacing life insurance products, including annuities. Instructions are on the cover page. Obtain and submit replacement form to expedite processing by redeeming carrier.

Used when replacing life insurance products, including annuities and with all new business in Virginia.

Used exclusively in Washington when replacing life insurance products, including annuities. Instructions are on the cover page. Obtain and submit replacement form to expedite processing by redeeming carrier.

Used exclusively in Wyoming when replacing life insurance products, including annuities. Instructions are on the cover page. Obtain and submit replacement form to expedite processing by redeeming carrier.

Used exclusively in Georgia when replacing life insurance products. Instructions are on the cover page. Obtain and submit replacement form to expedite processing by redeeming carrier.

New Account Enrollment