Get Conseco Fair Fund Reissue Request Form Non-ira Record Owner

This guide will help you navigate the process of completing the Conseco Fair Fund Reissue Request Form Non-IRA Record Owner online. By following the outlined steps, you will effectively provide the necessary information to process your request.

Follow the steps to successfully complete the Reissue Request Form

1. Click 'Get Form' button to obtain the form and open it in the online editor.
2. Complete Section A for accountholder information. This includes your first name, middle initial, and last name, along with your date of birth in MM/DD/YYYY format. Provide your Social Security Number or Employer Identification Number, along with your street address, apartment number, city, state, and ZIP code.
3. In Section A, also include your email address and preferred and alternate phone numbers for any necessary communications.
4. Indicate the name of the insurance company where your variable annuity fund account was held and provide the check number received.
5. Report your current state of residence and the reference number mentioned on your check.
6. Proceed to Section B to sign your request. You will need to certify that the information provided is accurate. Be aware of the tax implications stated in this section, including any federal or state tax withholding that may apply to your distribution.
7. Ensure you understand the affirmations regarding backup withholding and eligibility before signing. This includes noting your citizenship status and providing any applicable FATCA exemption codes.
8. Sign and print your name in the designated area and record the date you completed the form.
9. Once you have completed all sections, save your changes. You can then download, print, or share the completed form as needed.
10. Mail the signed form along with a voided check to the Fund Administrator at the provided address. Ensure that it is postmarked by the end of the appeal filing period.

Begin filling out your Conseco Fair Fund Reissue Request Form online today.