| Form Number | Description |
| Miscellaneous Non-Product Specific Forms
|---|
| 3600 | Assignment of Policy Release of Assignment |
| MONY-EFLOA ACH | Bank Acknowledgment and Authorization |
| 11622 | Billing Disbursement Election Form |
| 10481 | Change of Beneficiary and/or Rightsholder (Owner) |
| EFT500 | Electronic Funds Transfer (EFT) |
| GUL 503 | Group Universal Life Certificate Service Request Form |
| 15584 | MONY GUL Changes to Established Certificates Reinstatement Application, General |
| 4979 | MONY Service Request Form |
| 149043 | Overnight Fee and Aknowledgement Form |
| 12341 | Request For MONY-Matic Loan Repayment |
| 15579 | Request for Optional Service Telephone Fax Authorization |
| MONY-RMD Withdrawal | RMD Withdrawal Service Form |
| 3559 | Statement as to Trustee-Beneficiary |
| 3551 | Statement of Loss or Destruction |
| Annuities - B6000, C6000
|---|
| 15844LA | Flexible Payment Deferred Annuity Service Request |
| 15843LA | Flexible Payment Deferred Annuity Surrender |
| 15842LA | Flexible Payment Deferred Annuity Systematic Withdrawal Enrollment |
| 15246LA | Letter of Acceptance for Fund Transfers - Qualified, IRA and Non-Qualified Money |
| 16237LA | MONY 72(t) or 72(q) Substantially Equal Periodic Payment Exception Form |
| 15189 - (B6000, C6000) | MONY Master (FPVA) Dollar Cost Averaging Enrollment Form |
| 13343LA - (B6000, C6000) | MONY Master (FPVA) Service Request B6000/C6000 |
| 13345LA | MONYMaster (FPVA) Service Request |
| 13105 - (B6000) | Variable Annuity Service Form |
| 13362 - (B6000, C6000) | Variable Annuity Service Request-VALUEMaster |
| 15184LA | Variable Annuity Systematic Withdrawal Enrollment Form (MONYMaster Product Only) |
| Annuities - 1VA, 1VAA, 2VA, 2VAA, 1VAC, 2VAC, 1VAL, 2VAL
|---|
| 15448LA - (1VA, 2VA) | MONY/EFLOA Custom Master (FPVA) Systematic Withdrawal Enrollment Form |
| 16066LA - (1VA, 2VA) | MONY/EFLOA Custom Master Dollar Cost Averaging Enrollment Form (all states except NY) |
| 16087LA - (1VAA, 2VAA) | MONY/EFLOA Dollar Cost Averaging (DCA) Enrollment Form Variable Annuity |
| 15444LA - (1VA, 2VA) | MONY/EFLOA FPVA Surrender Loan 1VA 2VA |
| 15761LA - (1VAA, 2VAA) | MONY/EFLOA Variable Annuity FPVA Surrender/Withdrawal/Loan Form |
| 15759LA - (1VA, 1VAA, 2VA, 2VAA, 1VAC, 2VAC, 1VAL, | One-Time Transfer, Change of Allocations, Asset Rebalancing for Variable Annuity |
| 15908LA | Variable Annuity Surrender / Loan Form (all states except NY) |
| 15911LA - (1VAC, 2VAC, 1VAL, 2VAL) | Variable Annuity Systematic Withdrawal Enrollment Form (all states except NY) |
| Universal and Variable Life - B6000, C6000, 1VUL, 2VUL, 1SVL, 2SVL, 1VULA, 2SVULA, 2VULA, 2SVULA
|---|
| 15457LA - (1VUL, 2VUL, 1SVL, 2SVL) | Custom Equity Master Custom Estate Master Systematic Withdrawal Enrollment |
| 15542LA - (1VUL, 2VUL) | Custom Equity Master/Custom Estate Master Dollar Cost Averaging Enrollment (all states except NY) |
| 15455LA - (1VUL, 2VUL, 1SVL, 2SVL) | Custom Equity Master/Custom Estate Master Surrender/Loan |
| 15763LA - (Pre 6/3/2003 - 1VULA, 2SVULA, 2VULA, 2S | MONY Dollar Cost Averaging (DCA) Enrollment Form Variable Universal Life/Survivorship VUL |
| 16108LA - (Post 6/3/2003 - 1VULA, 2SVULA, 2VULA, 2 | MONY Dollar Cost Averaging(DCA) Enrollment Form Variable Universal Life - Introduced 6/2003 |
| 15625LA - (B6000, C6000) | MONY Equity Master Dollar Cost Averaging Enrollment Form |
| 15627LA - (B6000, C6000) | MONY Equity Master Surrender/Loan |
| 15454LA - (B6000, C6000, 1VUL, 2VUL, 1SVL, 2SVL, | One-Time Tranfer, Change of Allocations, Asset Rebalancing Life |
| 15755LA - (Pre 6/3/2003 - 1VULA, 2SVULA, 2VULA, 2S | Variable Universal Life Surrender/Loan |
| 16101LA - (Post 6/3/2003 - 1VULA, 2SVULA, 2VULA, 2 | Variable Universal Life Surrender/Loan - Introduced 6/2003 |
| 15778LA - (Pre 6/3/2003 - 1VULA, 2SVULA, 2VULA, 2S | Variable Universal Life Systematic Withdrawal Enrollment Form |
| 16110LA - (Post 6/3/2003 - 1VULA, 2SVULA, 2VULA, 2 | Variable Universal Life Systematic Withdrawal Enrollment Form - Introduced 6/2003 |
| Whole Life and Universal and Variable Universal Life - B1, C1, 1UL, 2UL, 1SULA, 2SULA
|---|
| 4979 | MONY Service Request Form |
| Contract Service Unit
|---|
| 35264 | Direct Deposit Authorization |
| 11363 | Federal Income Tax Statement of Elections |
