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Get Request For Disbursement Form For All Equi Vest Registered And Equi Vest Registered Expresssm

UEST FOR CHANGE OF BENEFICIARY 1. Owner s Information For Assistance: Call (800) 628-6673 Monday Thursday 8:00 a.m. 7:00 p.m. EST Friday 8:00 a.m. 5:00 p.m. EST Fax: (201) 583-2683 EQUI-VEST Processing Office P.O Box 4956 Syracuse, N.Y. 13221 (Contract number must be provided to process this request.) (All references to Contract include Certi cate and all references to Annuitant include Participant.) Certi cate/Contract Number Owner s Name (Last, First, Middle) Owner.

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