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Annuity Forms

We’ve compiled our most frequently requested customer service forms.

All the forms are in pdf and are available for viewing over the Internet with the Adobe Acrobat Reader. Acrobat Reader is available free of charge from Adobe.

Fax forms to: 513.794.4730 (Please note, not all forms can be returned via fax. Some forms require original signatures. Please call customer service to confirm.)

Mail to:
National Security Life and Annuity Company
Administrative Office
P.O. Box 5363
Cincinnati, OH 45201-5363

If you have any questions about completing any of these forms, please call Annuity Client Services at 877.446.6020 or e-mail

PDF Title Description Form# 
1 Electronic Funds Transfer Agreement for Direct Deposits Complete form to have payments directly deposited into an account of your choice. V-4620-A-NSLAC
2 Individual Annuity Contract Change Request - Full Surrender Complete form to request a full surrender V-4619.3-A-NSLAC
3 Individual Annuity Contract Change Request - Partial Surrender Complete form to request a partial surrender V-4619.3-B-NSLAC
4 Request for Systematic Withdrawal from an Annuity Complete form to start a series of partial surrenders V-4620-NSLAC
Internet Access Agreement
Privacy Policies and Practices
Victims of Domestic Violence
National Security Life and Annuity Company
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