Blank New York 8104 PDF Form

Blank New York 8104 PDF Form

The New York 8104 form is a crucial document used by policyholders to request changes regarding their life insurance dividends. This form allows individuals to specify how they would like their dividends to be applied, whether through cash payments, paid-up additions, or other options. For those looking to manage their life insurance benefits effectively, completing this form is essential; click the button below to get started.

The New York 8104 form is an important document for policyholders of New York Life Insurance Company, facilitating various requests related to life insurance policies. This form allows policy owners to change their dividend options, which can significantly impact the financial benefits of their policies. For instance, policyholders can choose to apply dividends toward premium payments, leave them to accumulate interest, or convert them into paid-up additions. Additionally, the form includes a section for income tax withholding elections, ensuring compliance with IRS regulations. Proper completion of the 8104 form is essential, as it requires personal information, including the policy number, owner details, and tax identification numbers. Understanding the implications of each option is crucial, as the choices made can affect future benefits and tax liabilities. The form also outlines specific instructions regarding deadlines and conditions for dividend changes, making it a vital tool for managing life insurance policies effectively.

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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)

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* (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

 

 

X

 

 

 

 

 

 

 

 

 

Policy Owner Signature

Name (Printed)

Date

 

 

RETURN FORM TO:

 

 

 

 

New York Life

 

 

 

 

P.O. Box 130539

 

 

 

 

Dallas, TX 75313-0539

 

 

 

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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

File Specifics

Fact Name Details
Form Purpose The New York 8104 form is used to change dividend options for life insurance policies issued by New York Life Insurance Company and its affiliates.
Dividend Change Timing Any changes to the dividend option will take effect on the current policy anniversary date if the request is received at least 31 days prior. Otherwise, it will take effect on the next anniversary.
Tax Withholding Requirements The IRS mandates completion of the tax withholding section. If no taxpayer identification number is provided, 10% of the taxable gain will be withheld automatically.
Applicable Governing Laws The form is governed by both federal tax laws and New York state insurance regulations. Specific state requirements may also apply based on the policyholder's residence.
Eligibility for Dividend Options Policies issued between April 7, 1975, and February 1, 1988, are eligible for Whole Life Additions. The options available depend on whether the policy includes a One Year Term rider.

How to Use New York 8104

Completing the New York 8104 form requires careful attention to detail. The form is used to request changes regarding dividend options for life insurance policies. Follow the steps outlined below to ensure accurate submission.

  1. Begin by entering the policy number at the top of the form.
  2. Fill in the name of the insured as it appears on the policy.
  3. If the policy owner is different from the insured, provide the policy owner’s name.
  4. Input the Social Security number or Tax ID for the policy owner. This is required.
  5. Provide a daytime phone number for contact purposes.
  6. Include an email address for correspondence.
  7. In the section for dividend option changes, select the appropriate box for policies with a one-year term option or without one.
  8. Choose the desired dividend option from the list provided. Options may include Paid-Up Additions, cash payments, or leaving dividends on deposit.
  9. If applicable, complete the Income Tax Withholding Section. Indicate your citizenship status and select your withholding preferences.
  10. Specify any percentages for federal and state withholding if you choose to have taxes withheld.
  11. Sign and date the form where indicated. Ensure the signature matches the name printed.
  12. Finally, return the completed form to the address provided at the bottom of the document.

Your Questions, Answered

  1. What is the New York 8104 form?

    The New York 8104 form is a document used by policyholders of New York Life Insurance Company to make changes regarding dividend options on their life insurance policies. It allows policyholders to select how they want their dividends to be applied, whether as cash, paid-up additions, or other options.

  2. Who needs to fill out the 8104 form?

    Any policyholder who wishes to change their dividend option or make a withholding election for tax purposes must complete the 8104 form. This includes those who have policies with New York Life or its subsidiaries.

  3. When does the dividend option change take effect?

    The change in the dividend option will take effect on the current policy anniversary date if the request is received by New York Life at least 31 days prior to that date. If the request is submitted after this period, the change will take effect on the next policy anniversary.

  4. What are the dividend options available on the 8104 form?

    Policyholders can choose from several options for their dividends, including:

    • Paid-Up Additions
    • Leave dividends on deposit to accumulate at interest
    • Apply dividends to pay premium and any loan interest due
    • Receive dividends in cash
    • Provide Whole Life Additions (specific eligibility applies)
  5. What should I know about tax withholding on the 8104 form?

    The form includes a section for income tax withholding. If you do not provide your Social Security number or Tax ID, federal law mandates that 10% of the taxable gain be withheld. You can choose to have federal and/or state taxes withheld, but specific rules apply based on your state of residence.

  6. Can I change my tax withholding election later?

    Yes, you can change your tax withholding election at any time. The new election will apply to any future payments from the same policy. However, if you do not specify a percentage for state withholding, it may not be withheld.

  7. What happens if I withdraw dividends before age 59½?

    If you withdraw dividends before reaching age 59½, a 10% IRS penalty may apply unless you qualify for an exception, such as being disabled. It's essential to consider this before making a withdrawal.

  8. Where do I send the completed 8104 form?

    Once you have completed the 8104 form, return it to New York Life at the following address:

    P.O. Box 130539, Dallas, TX 75313-0539

Common mistakes

  1. Missing Required Information: One common mistake is not providing the required Social Security number or Tax ID. This information is essential for processing the form. Without it, the request may be delayed or rejected.

  2. Incorrect Dividend Option Selection: People often select the wrong dividend option. It's crucial to carefully review the choices available for policies with and without a one-year term option. Selecting an option that does not apply to your policy can lead to complications.

  3. Not Meeting Deadlines: Failing to submit the form at least 31 days before the policy anniversary date can cause the dividend option change to take effect on the next anniversary instead of the current one. This can lead to unwanted delays in benefits.

  4. Ignoring Tax Withholding Requirements: Many individuals overlook the tax withholding section. Not specifying the desired withholding percentage can result in a default withholding of 10%, which may not align with the individual's tax situation. Understanding these options is important for proper tax management.

Documents used along the form

The New York 8104 form is essential for managing dividend options and tax withholding related to life insurance policies. Several other forms and documents complement this form, providing additional information and facilitating various processes. Below is a list of these documents.

  • Form W-9: This form is used to provide your correct taxpayer identification number (TIN) to the insurance company. It certifies that you are not subject to backup withholding and helps ensure accurate tax reporting to the IRS.
  • Form 1099: This document is issued by the insurance company to report any taxable gains from withdrawals made from your policy. It is important for tax filing purposes, as it details the amount that may be subject to federal income tax.
  • Form W-4P: This form allows policyholders to request federal income tax withholding from periodic pension or annuity payments. It helps specify the amount of tax to be withheld from payments received under the policy.
  • State Tax Withholding Form: Some states require their own forms to specify state income tax withholding. This document ensures compliance with state tax laws and allows policyholders to elect their withholding preferences.
  • Policy Loan Request Form: If a policyholder wishes to take a loan against their life insurance policy, this form is necessary. It outlines the terms of the loan and the amount requested, ensuring proper documentation of the transaction.

Understanding these forms and their purposes can help policyholders navigate their insurance policies more effectively. Each document plays a role in ensuring compliance with tax regulations and managing policy benefits.

Similar forms

The New York 8104 form is similar to the IRS Form W-4, which is used for withholding allowances. Both forms require individuals to make choices about tax withholding. Just as the W-4 allows employees to indicate how much federal income tax should be withheld from their paychecks, the 8104 form enables policyholders to elect how much tax should be withheld from their insurance payouts. Each form serves to ensure that the correct amount of tax is withheld, helping individuals avoid underpayment penalties at tax time.

Another document similar to the New York 8104 is the IRS Form W-9. This form is used to provide taxpayer identification information to entities that will report payments to the IRS. Like the 8104, the W-9 includes a certification section where the signer affirms their taxpayer status. Both forms require accurate information to prevent complications with tax reporting and withholding, ensuring compliance with federal regulations.

The New York 8104 form also resembles the IRS Form 1099, which reports various types of income other than wages. Just as the 1099 informs the IRS about income received, the 8104 helps determine how much tax should be withheld from insurance payouts. Both documents play critical roles in tax reporting, ensuring that individuals report their income correctly and comply with tax obligations.

Additionally, the New York 8104 is akin to the IRS Form 1040, which is the standard individual income tax return form. Both forms are essential for determining tax liabilities. While the 1040 is used to report overall income and calculate taxes owed, the 8104 focuses specifically on withholding choices related to insurance payouts. Together, they help taxpayers navigate their financial responsibilities.

The 8104 form is also similar to the IRS Form 8889, which is used for Health Savings Accounts (HSAs). Both forms require individuals to make elections regarding tax treatment. While the 8889 focuses on contributions and distributions from HSAs, the 8104 centers on tax withholding from insurance dividends. Both documents are crucial for ensuring that individuals understand their tax implications and make informed decisions.

Finally, the New York 8104 can be compared to the IRS Form 8606, which is used to report nondeductible contributions to traditional IRAs. Like the 8104, the 8606 helps individuals track tax implications over time. Both forms require careful attention to detail and accurate reporting to avoid future tax issues. They serve as important tools for individuals managing their financial assets and tax liabilities.

Dos and Don'ts

When filling out the New York 8104 form, it’s important to approach the process with care. Here are five essential tips to ensure your form is completed accurately:

  • Double-check your personal information. Ensure that your name, policy number, and Social Security or Tax ID are entered correctly. Any errors can lead to processing delays.
  • Understand the dividend options. Familiarize yourself with the different choices available for dividend distribution. This knowledge will help you make informed decisions that align with your financial goals.
  • Consult a tax advisor. Before making any elections regarding tax withholding, it’s wise to seek advice from a tax professional. They can provide guidance tailored to your specific situation.
  • Sign and date the form. Your signature is required for the form to be valid. Don’t forget to include the date, as this can affect the processing of your request.
  • Submit the form on time. To ensure your requests are processed by the desired date, send the form well in advance of any deadlines.

Conversely, here are five common mistakes to avoid when completing the form:

  • Don’t leave fields blank. Every required section must be filled out. Incomplete forms can lead to delays or rejections.
  • Avoid guessing on tax withholding. If you are unsure about the appropriate withholding percentages, do not make assumptions. Instead, consult a tax professional.
  • Don’t ignore state requirements. Be aware that some states have specific withholding rules. Familiarize yourself with these to avoid unexpected tax liabilities.
  • Do not submit without reviewing. Take a moment to review your completed form for accuracy. A quick check can prevent costly errors.
  • Never send the form without a copy. Always keep a copy of your submitted form for your records. This can be useful for future reference or in case of disputes.

Misconceptions

  • Misconception 1: The New York 8104 form is only for policy owners withdrawing cash.

    In reality, this form is used for various purposes, including changing dividend options and tax withholding elections. It's not limited to cash withdrawals.

  • Misconception 2: Once I submit the 8104 form, my changes take effect immediately.

    Changes to dividend options will only take effect on the current policy anniversary date if submitted at least 31 days prior. Otherwise, they will apply on the next anniversary.

  • Misconception 3: I can ignore tax withholding on my dividends if I don't want any taxes taken out.

    While you can elect not to have taxes withheld, you are still responsible for any taxes due on the taxable portion of your payment. Ignoring this could lead to penalties later.

  • Misconception 4: The form does not require my Social Security number or Tax ID.

    Providing your Social Security number or Tax ID is mandatory. Without it, federal law requires a 10% withholding on the taxable gain.

  • Misconception 5: I can choose any percentage for tax withholding without limitations.

    There are specific requirements regarding minimum withholding percentages, especially for federal taxes. If you don’t specify an amount, the default withholding will apply.

  • Misconception 6: The 8104 form is the same for all states regarding tax withholding.

    Each state has its own rules about tax withholding. Some states require withholding when federal taxes are withheld, while others have different requirements. Always check your state’s rules.

Key takeaways

Filling out the New York 8104 form is an important step for policyholders who wish to manage their life insurance dividends and tax withholding. Here are key takeaways to consider:

  • The form is used to change dividend options for life insurance policies issued by New York Life.
  • Requests for dividend option changes must be submitted at least 31 days before the policy's anniversary date to take effect that year.
  • Policyholders can select from various dividend options, including Paid-Up Additions and cash payments.
  • Specific options are available depending on whether the policy includes a One Year Term rider.
  • Tax withholding is a critical section that requires careful consideration; it is mandated by the IRS.
  • Failure to provide a Social Security Number or Tax ID may result in automatic withholding of 10% from taxable gains.
  • Policyholders can choose to withhold federal and/or state income taxes, but certain restrictions may apply based on state regulations.
  • Consultation with a tax advisor is recommended to understand the implications of withholding elections.
  • Changes to dividend options may affect any insurance provided by additional riders attached to the policy.
  • Returning the completed form to New York Life is essential to ensure that the requested changes are processed.

Understanding these points can help policyholders navigate the complexities of the New York 8104 form effectively.