For Agents
Annuity Forms
Applications, supplemental forms, and service forms for Mountain Life annuity business.
New Business
New Business Forms
Florida has its own application package and supplemental forms. Choose a jurisdiction.
New Business Forms – Except Florida
Application Forms
Supplemental Forms
- EFT Authorization (PDF, opens in a new tab)
- Replacement of Life Insurance or Annuities (PDF, opens in a new tab)
- 1035 Exchange / Rollover / Transfer (PDF, opens in a new tab)
- Consumer Refusal to Provide Information (PDF, opens in a new tab)
- Consumer Decision to Purchase an Annuity NOT Based on a Recommendation (PDF, opens in a new tab)
- Non Natural Corporation Supplemental Form (PDF, opens in a new tab)
- Certification of Trust and Trustee Powers (PDF, opens in a new tab)
- Power of Attorney (PDF, opens in a new tab)
- Wire Transfer Instructions (PDF, opens in a new tab)
- Non-Resident Information Form (PDF, opens in a new tab)
State-Specific Forms
Forms published for a specific state, in addition to the forms above.
Ohio
New Business Forms – Florida Only
Application Forms
Supplemental Forms
- EFT Authorization (PDF, opens in a new tab)
- Replacement of Life Insurance or Annuities (PDF, opens in a new tab)
- 1035 Exchange / Rollover / Transfer (PDF, opens in a new tab)
- Comparative Information Form (PDF, opens in a new tab)
- Consumer Refusal to Provide Information (PDF, opens in a new tab)
- Consumer Decision to Purchase an Annuity NOT Based on a Recommendation (PDF, opens in a new tab)
- Non Natural Corporation Supplemental Form (PDF, opens in a new tab)
- Certification of Trust and Trustee Powers (PDF, opens in a new tab)
- Power of Attorney (PDF, opens in a new tab)
- Wire Transfer Instructions (PDF, opens in a new tab)
- Non-Resident Information Form (PDF, opens in a new tab)
Policy Service
Service Forms
For in-force contracts. The live page lists these same forms for every jurisdiction, including Florida.
- Contract Information Change Form (PDF, opens in a new tab)
- Withdrawal/Surrender Request (PDF, opens in a new tab)
- Required Minimum Distribution (RMD) Form (PDF, opens in a new tab)
- Direct Deposit Authorization (PDF, opens in a new tab)
- Roth IRA Conversion Request Form (PDF, opens in a new tab)
- Qualified Charitable Distribution Request Form (PDF, opens in a new tab)
Questions about a form or a submission? Call (800) 888-6542 or email contact@mountainlife.com.