The forms listed below can be used for a variety of contract-related activities including, but not limited to, withdrawals, beneficiary changes, fund transfers and maintenance. Please review each form carefully. Some of the resulting transactions may generate a financial or tax impact on your contract. Please consult with your registered representative or tax advisor for assistance in determining the appropriateness of a proposed transaction. The fillable form icon indicates that the form can be opened, filled-in, and then printed. Fillable forms cannot be saved or emailed with filled in data. Select the desired form from the list below.
Contract Maintenance Fill-in Disability Certification [N638-07A] Lost Contract Affidavit and Agreement [N363-5A] NY Rider and Asset Allocation Options Request [NE705109A] Preauthorized Investment Request [NE571908A] Predetermined Beneficiary Payout Option [N1643-07B] Qualified Plan Disclosure [NE557808C] Request for Tax ID Number [W-9] Required Minimum Distribution Request [NE603208A] SIMPLE IRA Employer Information [N334-07A] Tax-Sheltered Annuity Certification TSA/403(b) [NE661309A] Telephone/Electronic Authorization [NE732908B] Transfer/Exchange [NE552209A] Transfers & Allocations [NE675009A] Trustee Certification and Disclosure [NE674008A] Withdrawal Request For Guaranteed Minimum Withdrawal Benefit Riders [NE569009A] Withdrawal Request [NE631209A] Withholding Certificate for Pension or Annuity Payments [W-4P]	If you have questions regarding how to complete these forms, please contact our Customer Service Specialists at (800) 748-6907. AVOID HIGHLIGHTING Important! Avoid using the highlighter on forms submitted to Pacific Life. Forms are scanned into an imaging system at Pacific Life and highlighting can obscure written entries and instructions.
How to Read Your Quarterly Statement Sending Business to Pacific Life