The New York 8104 form is a critical document for policyholders of the New York Life Insurance Company, NYLIFE Insurance Company of Arizona, and New York Life and Annuity Corporation (A Delaware Corporation), allowing them to modify the dividend option associated with their insurance policy. This form enables policyholders to specify how they wish to receive dividends from their policy, such as through paid-up additions, leaving dividends to accumulate at interest, applying dividends to pay premiums or loans, and more. Additionally, it includes sections for income tax withholding elections, ensuring policyholders comply with federal and state tax requirements.
The New York 8104 form, a critical document for policyholders of the New York Life Insurance Company, the NYLIFE Insurance Company of Arizona, and the New York Life and Annuity Corporation, delineates the procedure for changing the dividend option associated with a life insurance policy. This comprehensive form addresses several pivotal areas, including insured and policy owner information along with the requisite social security or tax identification numbers, and outlines numerous dividend options that policyholders might adjust to, such as Paid-Up Additions, accumulation of dividends at interest, premium payment facilitation, and cash payments among others. Significantly, the form necessitates a submission at least 31 days before the policy anniversary to effectuate changes for the current year, underscoring the importance of timely submissions. Additionally, it incorporates an Income Tax Withholding section mandated by the Internal Revenue Service (IRS), necessitating policyholders to make informed decisions about federal and state tax withholdings on their dividends, which are meticulously detailed to guide policyholders through various scenarios and requirements based on their resident state. Moreover, the form serves a dual function of capturing a policyholder’s tax compliance declaration and facilitating the alteration of dividend distribution methods, ultimately aiding policyholders in navigating the complexities of insurance dividends and tax implications.
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New York Life Insurance Company
NYLIFE Insurance Company of Arizona
New York Life and Annuity Corporation
(Not licensed in every state)
(A Delaware Corporation)
4343 North Scottsdale Rd, Suite 220
51 Madison Avenue, New York, NY 10010
Scottsdale, AZ 85251
www.newyorklife.com
Insured Information
Policy Number
Name
Policy Owner information
Name (if different than above)
Social Security */ TAX ID (Required)
Daytime Phone #
Email
Dividend Option Change
The dividend option change will become effective on the current policy anniversary date, if this request is received by New York Life at least 31 days prior to the current policy anniversary date. Any requests received after this period will take effect on the next policy anniversary.
Note: If your policy contains the Dividend Option Term rider, the dividend option must be Paid-up Additions. Whole Life Additions are only available for policies issued between issued between April 7, 1975 and February 1, 1988.
A.Policies With One Year Term Option (Select one box below)
Cancel the ONE YEAR TERM Rider and apply dividends payable as elected in Section B OR
Retain the ONE YEAR TERM Rider, but change the option for the balance of dividends payable, as elected below :
(Check one)
Provide Paid-Up Additions
Leave on deposit with New York Life to accumulate at interest
Apply to pay premium and any loan interest due; pay balance in cash*
Apply toward payment of premium only; pay balance in cash
Pay in cash
Provide Whole Life Additions
B.Policies Without One Year Term Option (Select one box below)
Apply toward payment of premium only; pay balance in cash*
Provide Whole Life Additions* (See note above)
Change the current dividend option to cash and apply the cash dividend proceeds to pay policy loan interest due, then repay any policy loan on this policy. When any loan interest which is due and any policy loan has been repaid, change the dividend method to provide Paid-up Additions. Any remaining cash dividend for the year in which this change occurs should be applied under that dividend method
*This dividend option is available only when the mode of payment is one that has a premium falling due on the policy anniversary date. This dividend option request also authorizes a change of mode to annual, if no other mode is selected, and/or the withdrawal or sufficient dividends to pay the balance of the premium due, if necessary.
I understand that any insurance provided by an Expanded Protection Benefit rider will terminate on the date immediately preceding the policy anniversary when the new dividend option takes effect.
8104 (6/2016) Page 1 of 3
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I wish to elect Added Value Advantage
Income Tax Withholding Section
IMPORTANT: The Internal Revenue Service (IRS) requires that you complete this section. See important tax information below before you make your withholding election. If your social security number (SSN) or taxpayer identification number (TIN) is not furnished, we are required by Federal law to withhold 10% of the taxable gain. Withholding election is not required for withdrawal from Dividend Deposits.
Are you a citizen of the United States (including a resident alien)? Yes
No
I elect to have the following withholding option applied to this payment and any future payment(s) under this policy (check only one box):
NO Federal or State Income taxes will be withheld
ONLY Federal Income taxes withheld
(This option may not be available for residents
of certain states. See the State Income Tax
Withholding section of this form)
BOTH Federal and State Income taxes will be withheld
ONLY State income taxes withheld
If you elected any of the option above in which taxes will be withheld, you can specify the tax withholding percentage(%) of each withdrawal you would like to have applied to Federal and/or State income tax withholding. If a specific tax withholding amount is not indicated below, we will withhold 10% for federal tax purposes and the state’s minimum withholding (if applicable). Please fill in items (1) and (2) below.
(1)I would like to apply _____% of the taxable portion to Federal Withholding.
(2)I would like to apply _____% of the taxable portion to State Withholding.
If you elect to have Federal Income tax withheld, we are required to withhold at least 10% of the taxable portion of the distribution. If your state requires withholding, we will withhold the state’s minimum amount if you select an amount that is less than the minimum. Please see Important State Income Tax Withholding Information section.
Policyowner’s Signature (REQUIRED)
Under penalties of perjury, I (as owner named) certify: (1) my social security number or Tax ID number shown on this form is my correct taxpayer identification number, (2) I am not subject to back withholding because (a) I am exempt from backup withholding; or (b) I have not been notified by the IRS that I am subject to backup withholding as a result of a failure to report all interest or dividend income; or (c) the IRS has notified me that I am no longer subject to backup withholding, (3) I am a U.S. person (includes a U.S. resident alien), and (4) I am exempt from Foreign Account Compliance Act (FATCA) reporting.
Check this box if the IRS has notified you that you are subject to backup withholding.
If I am not a U.S. citizen, U.S. resident alien or other U.S. person, I am submitting the applicable Form W8 with this form to certify my foreign status and if applicable, claim treaty benefits.
The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.
X
Policy Owner Signature
Name (Printed)
Date
RETURN FORM TO:
New York Life
P.O. Box 130539
Dallas, TX 75313-0539
8104 (6/2016) Page 2 of 3
Important Tax Information
You should consider very carefully which box you check above. You should consult with your personal tax advisor, plan administrator, State income tax authority, or your local IRS office if you have any questions about income tax withholding. IRS publication 505 (Tax Withholding and Estimated Tax) and IRS forms W-9 and W-4P.
Federal Income Tax Withholding
A dividend withdrawal from your policy may result in a taxable gain reportable to the IRS on Form 1099. Federal income taxes must be withheld at a flat 10% rate from the taxable portion of your payment (as determined from our records), unless you elect not to have withholding apply by checking the appropriate box in the Income Tax Withholding Election section on this form. Non-persons such as corporations, companies, trusts, etc. or U.S. citizens living outside the United States cannot elect out of withholding. (Your election as to whether taxes are or are not to be withheld will apply to any other payments from the same policy. You may change your withholding election at any time.) In addition, a 10% IRS penalty may be imposed if you receive the withdrawal prior to age 59½, unless you are disabled or some other exception applies.
Even if you elect not to have Federal income tax withheld, you are liable for payment of such tax on the taxable portion of your payment. There are penalties under the estimated tax payment rules if enough tax has not been paid through either estimated tax payments or withholding. If the taxable portion of a payment when added to the taxable portion of all other payments during the year is less than $200, Federal income tax is not required to be withheld.
State Income Tax Withholding
In addition to the Federal income tax withholding requirements, some states require withholding on policy gains when federal income tax is withheld. As of January 1, 2012, the following states require state income tax withholding when federal income tax withholding is in effect: Iowa, Kansas, Maryland, Massachusetts, Nebraska, Oklahoma, and Virginia. If you live in Arkansas, California, Delaware, Georgia, Maine, North Carolina, Oregon, or Vermont we are required to withhold state income tax if federal income tax withholding is in effect, unless you elect not to have state income tax withheld. If you live in Michigan, we are required to withhold state income tax from the taxable portion of your payments, unless you provide us with a properly completed Form MI W-4P and you claim an exemption from withholding. Certain exceptions and special rules apply in some states. For more information regarding the withholding requirements applicable in your state, please consult your tax advisor or state tax authority.
If you reside in any of the following states and request state tax withholding, you must also specify the percentage of state tax withholding that you choose to apply to the taxable portion of the withdrawal: Alabama, Colorado, Connecticut, District of Columbia, Idaho, Illinois, Indiana, Kentucky, Louisiana, Minnesota, Missouri, Montana, New Jersey, New Mexico, New York, North Dakota, Ohio, South Carolina, Utah, West Virginia, and Wisconsin. In these states, if a percentage is not specified, state tax will not be
withheld.
8104 (6/2016) Page 3 of 3
Filling out the New York 8104 form is a straightforward process but requires your attention to detail, especially because it involves selecting dividend options and possibly addressing tax withholdings on the dividends from your New York Life Insurance policy. Once completed, this form will enable you to update the dividend option on your policy, which could have implications for the growth or use of your policy's value over time. Follow these guidelines to ensure the accurate completion of the form.
Take a moment to review your entries on the form for accuracy and completeness. It's crucial to check that the dividend options selected align with your financial goals and policy's terms. Remember, the choices you make regarding dividends and tax withholdings can impact the policy's cash value growth and your tax liability. If you have any uncertainties or require clarification on how a particular section applies to your situation, seeking advice from a tax professional or financial advisor is advisable. Once submitted, keep a copy of the completed form for your records and monitor any expected changes to your policy to ensure they are processed as requested.
What is the New York 8104 form?
The New York 8104 form is a document used by policyholders of the New York Life Insurance Company, NYLIFE Insurance Company of Arizona, and New York Life and Annuity Corporation to request changes to their dividend options on their insurance policies. It allows for the modification of how dividends are to be used, such as applying them towards premium payments, accumulating interest, or receiving them in cash, among other options.
When do changes requested on the 8104 form become effective?
Changes requested on the 8104 form become effective on the current policy anniversary date, provided New York Life receives the form at least 31 days prior to that date. If received later, changes will take effect on the next policy anniversary.
What options are available for utilizing dividends according to the 8104 form?
What is required for the income tax withholding section on the form?
The form requires policyholders to indicate their U.S. citizenship status and make an election regarding federal and/or state income tax withholding on distributions from the policy. Specific percentages for withholding can be elected, and failure to provide a social security number or taxpayer identification number will result in mandatory federal withholding.
Are there specific dividend options available only for certain policies?
Yes. Whole Life Additions as a dividend option are only available for policies issued between April 7, 1975, and February 1, 1988. Additionally, certain dividend options are only available if the policy's payment mode coincides with a premium due on the policy anniversary date.
What happens to an Expanded Protection Benefit rider when changing dividend options?
The insurance coverage provided by an Expanded Protection Benefit rider will terminate on the date immediately preceding the policy anniversary when a new dividend option takes effect.
Can policyholders change their income tax withholding election in the future?
Yes, policyholders can change their withholding election at any time to suit their tax preferences or needs.
What states have specific requirements for state income tax withholding?
States such as Iowa, Kansas, Maryland, Massachusetts, Nebraska, Oklahoma, Virginia, among others, have specific requirements for state income tax withholding, especially when federal income tax is withheld. Policyholders should consult the form for specific states mentioned and are encouraged to consult a tax advisor for detailed guidance.
How should policyholders submit their completed 8104 forms?
Completed forms should be returned to New York Life at the provided P.O. Box address in Dallas, TX. It is essential to ensure that the form is signed and dated by the policy owner.
Why is it advised to consult with a tax advisor or state tax authority?
Since tax implications may vary based on individual circumstances and state laws, consulting with a tax advisor or the state tax authority can provide policyholders with personalized advice and help them make informed decisions about income tax withholding and other tax-related matters on their policy gains.
When filling out the New York 8104 form for changes to a life insurance policy's dividend options or addressing income tax withholding, there are several common mistakes policy owners often make. Awareness of these errors can help ensure that the forms are filled out accurately and that the intended requests are processed without unnecessary delay.
Firstly, a frequent oversight involves the section on Dividend Option Change. Policyholders sometimes neglect to select an option for the handling of their dividends, especially between retaining the ONE YEAR TERM Rider or altering the dividend application method. This mistake can lead to dividends not being utilized in a manner that aligns with the policy owner's current financial strategies or goals.
Another error occurs within the Income Tax Withholding Section. Policyholders must indicate their citizenship status and make a withholding election for federal and, if applicable, state taxes. Failing to complete this section or making an unclear election can result in automatic withholding at default rates, potentially leading to unexpected tax implications or a mismatch in the policy owner's tax management plan.
In summary, it's crucial for policy holders to carefully review and accurately complete the New York 8104 form. Paying close attention to each section, especially those regarding dividend options and tax withholding, ensures that the policy adjustments are made efficiently and according to the owner's wishes. Proper completion helps avoid unnecessary delays and ensures compliance with federal and state tax requirements.
When handling insurance matters, particularly with New York Life Insurance Company, it's common to fill out and submit the New York 8104 form. However, this form is often just a part of the documentation needed to effectively manage or adjust a life insurance policy. Several other forms and documents frequently accompany the New York 8104 form to ensure comprehensive policy management, updates, or changes.
Each of these documents plays a vital role in the management of a life insurance policy. Whether it's fulfilling IRS requirements, updating policy details, or ensuring premium payments, being familiar with these forms will streamline the process of managing life insurance policies with New York Life Insurance Company. Knowledge and proper completion of the applicable documents can significantly impact the policy's effectiveness and the policyholder's peace of mind.
The New York 8104 form, largely centered around life insurance policy modifications and tax withholding elections, shares similarities with several other financial and insurance-related documents. One such parallel can be drawn with the W-9 Form, used in the U.S. to collect taxpayer identification numbers. Like the portion of the New York 8104 form requiring the policy owner's Social Security or Tax ID number, the W-9 is crucial for ensuring proper identification and tax reporting to the IRS, making both documents integral to tax compliance and the prevention of tax evasion.
Another related document is the Change of Beneficiary form, commonly used in life insurance policies to update the designated recipient of policy proceeds upon the death of the insured. While the New York 8104 focuses on dividend options and tax withholding preferences, both types of forms involve making significant changes to a life insurance contract. Specifically, they highlight the policy owner's ability to make adjustments that better align with their changing financial or personal circumstances, underscoring the flexibility inherent in managing life insurance products.
The Loan Request form associated with life insurance policies also shows resemblance to the 8104 form. This document is used when the policy owner wishes to borrow against the cash value of their life insurance policy. Similar to how the 8104 allows policyholders to change dividend options or address loans and interest, the Loan Request permits access to funds within the policy's value under certain conditions. Both forms demonstrate ways policyholders can leverage their policies for financial management or liquidity purposes.
Lastly, the W-4P, Withholding Certificate for Pension or Annuity Payments, is notably similar to the tax withholding section of the New York 8104 form. Both allow the individual to control the amount of tax withheld from distributions (in the case of the 8104, from dividends or withdrawals), thereby managing their tax liability and adhering to IRS requirements. This shared attribute emphasizes the importance of tax planning in both pension income and life insurance benefits, allowing recipients to tailor withholding to their needs and potentially avoid underpayment penalties.
When filling out the New York 8104 form, there are several guidelines you should follow to ensure the process is completed accurately and efficiently. Here are key do's and don'ts to consider:
Understanding the nuances of the New York 8104 form is crucial for policyholders to make informed decisions regarding their life insurance dividends. However, there are several misconceptions about this form that need to be clarified:
It's essential for policyholders to carefully review and understand the New York 8104 form, ensuring their choices align with their financial goals and needs. Consulting with a professional can also provide clarity and help avoid common misconceptions.
Filling out and using New York Life's 8104 form is crucial for policyholders looking to make changes to their dividend options or update their personal details. Here are six key takeaways to guide you through this process:
Understanding these key points will help you confidently navigate the process of filling out and submitting the 8104 form, ensuring that you make informed decisions about your New York Life policy.
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