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Annuity Forms

Find and download the form you need. Print, complete, and sign. Then send it to:

Vantis Life
Policy Services Dept.
PO Box 310
Millville, NJ 08332-0310

Fax 860-298-5483

Questions?  Call customer service at 1-866-826-8471. We are available Mon-Fri 8:30am - 6:00pm ET.

The forms are in Adobe PDF format. 

  • 10-Day Cancellation Request
  • Annuity Change Request Form
 
  • Direct Deposit Authorization
 
  • Request for Duplicate Contract
 
  • Required Minimum Distribution Form
 
  • Non-Periodic Distribution Request Form
 
  • Periodic Distribution Request Form
 
  • Premium Deposit/Loan Payment Form
 
  • Systematic Distribution Request Form
 
  • Tax Free Transfer Request Form
 
  • Witholding Notice Information
 

The following forms are specific to NY state customers:

  • 10-Day Cancellation Request
 
  • Annuity Change Request Form
 
  • Direct Deposit Authorization
 
  • Request for Duplicate Contract
 
  • Required Minimum Distribution Form
 
  • Non-Periodic Distribution Request Form
 
  • Periodic Distribution Request Form
 
  • Premium Deposit/Loan Payment Form
 
  • Systematic Distribution Request Form
 
  • Tax Free Transfer Request Form
 
  • Witholding Notice Information
 

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© Copyright Vantis Life Insurance Company, Windsor, Connecticut, USA - All Rights Reserved.

Vantis, Vantis Life, and "A better life experience" are registered trademarks of Vantis Life Insurance Company. Life insurance and annuities issued by Vantis Life Insurance Company, Windsor, CT (all states except NY) and by The Penn Insurance and Annuity Company of NY, Brewster, NY (NY only). Products not available in all states and state variations may apply. Prices may vary based on individual factors. You'll be asked questions to determine your eligibility. Policy and rider form numbers and features may vary by state and may not be available in all states. Price and offers are determined by age, health and lifestyle and are subject to change.

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