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

Overnight address
Vantis Life
302 High St #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. 

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 
Termination Request Form 
Witholding Notice Information 

The following forms are specific to NY state customers:

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

The Penn Insurance and Annuity Company of New York
PO Box 390
Millville, NJ 08332-0390

Overnight address
The Penn Insurance and Annuity Company of New York
302 High St #390
Millville, NJ 08332-0390

Questions? Call customer service at 1-855-436-0952. We are available Mon-Fri 8:30am - 6:00pm ET.

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 
Termination Request Form 
Witholding Notice Information