The forms listed below can be used for a variety of contract-related activities including, but not limited to, withdrawals, beneficiary changes, fund transfers and maintenance. Please review each form carefully. Some of the resulting transactions may generate a financial or tax impact on your contract. Please consult with your registered representative or tax advisor for assistance in determining the appropriateness of a proposed transaction. The fillable form icon indicates that the form can be opened, filled-in, and then printed. Fillable forms cannot be saved or emailed with filled in data. Select the desired form from the list below.

Contract Maintenance Fill-in Annuity Contract Change Request [E626207A] Disability Certification [2774-07A] Lost Contract Affidavit [363-07A] Preauthorized Investment Request [E569308A] Predetermined Beneficiary Payout Option [1643-07B] Qualified Plan and 457(b) Plan Disclosure [E557708C] Request for Tax ID Number [W-9] Required Minimum Distribution Request [E603108A] Rider and Asset Allocation Options Request [E705008B] SIMPLE IRA Employer Information [334-07B] Tax-Sheltered Annuity Certification TSA/403(b) [E550808A] Telephone/Electronic Authorization [E732808B] Transfer/Exchange [E546708B] Transfers and Allocation [E674908B] Trustee Certification and Disclosure [E673908A] Withdrawal Request - For Guaranteed Minimum Withdrawal Benefit Riders [E597408D] Withdrawal Request - Pacific Frontiers [658-07A] Withdrawal Request [E572408B] Withholding Certificate for Pension or Annuity Payments [W-4P]

If you have questions regarding how to complete these forms, please contact our Customer Service Specialists at . AVOID HIGHLIGHTING Important! Avoid using the highlighter on forms submitted to Pacific Life. Forms are scanned into an imaging system at Pacific Life and highlighting can obscure written entries and instructions.