Sales & Service Forms
All forms may be submitted electronically. If you are unable to find what you are looking for, contact us at (800) 617-2861 or email the Structured Settlements team.
Applications
Please complete one application for each annuitant on a case.
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Application for Assigned Cases
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Application for Unassigned Cases
For use with unassigned cases in all states except AR, AZ, DC and FL. State specific versions required in AZ, AR, DC and FL.
ICC11-705-GANA-11 (PDF)
ICC11-705-GANA-11 ARIZONA (PDF)
ICC11-705-GANA-11 ARKANSAS (PDF)
ICC11-705-GANA-11 DC (PDF)
ICC11-705-GANA-11 FLORIDA (PDF)Application - Supplemental Payment Schedule
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State Specific Disclosure Docs
The following disclosures are required when submitting business in FL and MA. We will complete the applicable disclosure upon your request.
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Application Supplemental Beneficiary Form
Complete if more than two beneficiaries are requested.