Telephone Authorization Form - New York Life
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NEW YORK LIFE INSURANCE AND ANNUITY CORPORATION
(A Delaware Corporation)
TELEPHONE AUTHORIZATION FORM
HOW TO INITIATE TELEPHONE AUTHORIZATION
This telephone authorization form can be used to authorize you or anyone else you name to request transfers among Investment
Divisions and/or the Fixed Account or to change the allocation of future payments to your policy. Complete and sign this form, and send
it to:
If you have any questions, please contact one of our Customer Service Representatives at the Variable Products Service Center
toll-free at 1-800-598-2019.
For online policy information and service, please visit our Virtual Service Center at
POLICY AND OWNER INFORMATION
Policy Number:
Insured(s)/Annuitant:
Policyowner:
Address:
Street
City
State
Zip
Policyowner’s Telephone Numbers:
(
)
(
)
Home
Business
ADDITIONAL INDIVIDUALS TO BE AUTHORIZED
: An Insured/Annuitant, if other than the policyowner, does not have access to
telephone authorization, unless designated.
Please note: A Registered Representative of NYLIFE Securities (current and former) may not be given authorization to request
transactions on behalf of their clients. Authorization to these Registered Representatives will be limited to accessing policy information
only.
Name and Relationship
Name and Relationship
Variable products are distributed by NYLIFE Distributors LLC, Member FINRA/SIPC and offered through properly licensed registered representatives.
RETURN FORM TO:
For Variable Life and Variable Annuity policies:
New York Life, Variable Products Service Center
Madison Square Station, PO Box 922, New York, NY 10159
21114 (08/08)
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