Form # Form Name Description VL 22551 1035 Exchange In Form Used to initiate a Section 1035 Exchange In from an outside carrier to a VALIC account. Send forms directly to Home office for processing. Home office will obtain signoff on suitability from Regional Compliance Analyst. VL 6201 Annuity Benefits Form Used to select a Payout option (payment frequency and method) when annuitizing a clients account. VL 6730 Bank Deposit Agreement Used by a client to authorize VALIC to transfer funds to a bank account as specified by the client. PDF only. VL 8725 Cash Distribution Form Used to initiate distribution of a partial withdrawal, maximum withdrawal or full surrender. VL 995 Death Claim Form Used by a beneficiary to claim proceeds from a participants account after death. VL 23554 Extended Care Rider Claimant Statement Used with Premiere 5 and 7, Power Index and (Proflex Independent Channel only) products, to provide proof of extended care in order to waive the contracts early withdrawal charge. VL 18546 Forms Usage Guide for Independent Channel Partners Used to describe the forms needed to complete transactions involving External Broker Dealers selling VALIC products. VL 9006 Internal Combination Rollover Form Used to request account combination (different group,plan,subgroup to one account) or internal rollover from one VALIC account to another. For product exchanges use VL9034. Minimum Distribution required prior to rollover if client has attained age 70.5. VL 5320-MAINT Maintenance Distribution Form Used for changes to an existing periodic payment associated with a Required Minimum Distribution (RMD) only. VL 5320 Minimum Distribution Form Used to initiate the minimum distribution for group sponsored plans clients only as required by the IRS. VL 5320-EZ Minimum Distribution Form - Easy Used for RMD set ups for group sponsored plans only clients where VALIC calculated, pro-rata, multi-year automatic recurring payments. Use RMD Maintenance Form for making changes to an existing RMD. Use Beneficiary Distribution form for beneficiary distributions. Do not use this form for IRA plans. VL 5320-IRA Minimum Distribution Form - IRA Used for RMD set ups for IRA only clients where participant calculates RMD payment, prior year payments, non pro-rata fund selection, joint life expectancy calculation, reinvestment into an existing nonqualified deferred annuity. Use RMD Maintenance Form for making changes to an existing RMD. Use Beneficiary Distribution form for beneficiary distributions. Do not use this form for group sponsored plans. VL 5320-IRA-EZ Minimum Distribution Form - IRA Easy Used for RMD set ups for IRA only clients where VALIC calculated, pro-rata, multi-year automatic recurring payments. Use RMD Maintenance Form for making changes to an existing RMD. Use Beneficiary Distribution form for beneficiary distributions. Do not use this form for group sponsored plans. VL 28668 Qualified Charitable Distribution Supplemental Form Used when the client has an IRA account and wants to send distribution payments to a qualified 501(c)(3) organization that is eligible to receive tax deductible contributions. Must be used with another VALIC distribution form. VL 8715 Record of Additional Deposit Used to transmit an additional contribution for a client and for providing the client with a receipt. Complete only as needed. VL 25190 Record of Contribtuion Used by the Independent Channel to transmit an additional contribution for a client and for providing the client with a receipt. Complete only as needed. VL 25031 Request to Transfer NQDA or Non-insurance Funds to VALIC Used exclusively by external broker-dealers to liquidate Nonqualified or Non-Insurance accounts and transfer funds to VALIC. VL 316-Roth Roth IRA Acknowledgment Used to request an internal Roth IRA conversion of an existing account for American Pathway Elite 4 and 7. VL 8725-C SONJ State of New Jersey (SONJ) Cash Distribution Form Used to initiate distribution of a partial withdrawal, maximum withdrawal or full surrender. VL 20795 Systematic Withdrawal Form Used to establish a systematic withdrawal of a designated amount, designated number of years or substantially equal payments. Version 10-2002 includes the Fixed Interest Only option feature and allows for fund selection. Use form VL 20795-LB if the account has a living benefit. VL 20795-LB Systematic Withdrawal Form - With Living Benefit Used for accounts with living benefits to establish a systematic withdrawal of the MAWA or a designated amount less than tor equal to the MAWA. This form should only be used for accounts with living benefits. Use form VL 20795 if the account does not have a living benefit. VL 23767 Terminal Illness Rider Claimant Statement Used with Power Index and (Proflex Independent Channel only) products, to provide proof of terminal illness in order to waive the contracts early withdrawal charge. VL 18484 Transfer-Rollover In For Use with VALIC Independent Channel Used exclusively by external broker-dealers to transfer-rollover in funds for ALL PLAN TYPES from a client account at another carrier to VALIC. VL 22140 VALIC Hardship Distribution Form Used to request withdrawal or distribution for funds for hardship reasons. VL 12837 VALIC Unforeseeable Emergency Withdrawal Form Used to make a withdrawal of funds from 457 plans for unforeseeable emergencies.