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Get Western Reserve Life Annuity Distribution Form

Full Surrender Request Fax 800-235-4782 Policy/certificate number (s) Insured/Annuitant Owner Phone Number Fill out all required information in Sections 1 and 2. Owner(s) must sign and date form in space provided below. 1. Full Surrender Select one (Refer to #2 below. Subject to any IRS early withdrawal penalties.) Request termination of policy/certifi.

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