Annuity Forms

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

Vantis Life
Policy Services Dept.
PO Box 103
Brattleboro, VT 05302-0103

Fax 860-298-5483

Questions? Call customer service at 1-866-826-8471

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

Annuity Forms

Customer Service