State Specific Tax Withholding Certificates Guide

Some states require the use of their state specific form(s). Below is a listing of the required state specific forms Pacific Life is aware of as of June 2024, which may change over time. Please consult with your tax advisor whether or not such a form is required based on your specific situation.  Additional information can generally be found on your state’s tax website. In situations where a state specific form is required, the form must be included with the applicable distribution form, or we may be required to withhold a default amount.

State State Form Required Additional Details
Arizona A-4 Applies for periodic payments only.
Connecticut CT A-4 Applies for periodic payments only.
Minnesota W-4MNP Applies for both periodic and non-periodic payments.
Oklahoma OK W-4P and OK W-4R Applies for both periodic and non-periodic payments.

The above guide is provided as a tool to help understand states that require state specific withholding forms. Pacific Life uses best efforts to gather information on these forms, however as these are managed by the individual states and changes may occur without Pacific Life’s knowledge, we cannot guarantee the accuracy, or timeliness of updates to the above chart. Any withholding elections for repetitive payments will continue unless Pacific Life receives a valid updated withholding request reflecting different elections. The state of residency is determined by the address on record for the contract, which may or may not be the individual’s state of residency for tax purposes. Please contact a tax professional regarding withholding elections for a particular state to answer any questions regarding their withholding laws.



Pacific Life, its distributors, and respective representatives do not provide tax, accounting, or legal advice. Any taxpayer should seek advice based on the taxpayer's particular circumstances from an independent tax advisor or attorney.

Pacific Life is a product provider. It is not a fiduciary and therefore does not give advice or make recommendations regarding insurance or investment products.

Unless otherwise noted, all aforementioned money managers, their distributors, and affiliates are unaffiliated with Pacific Life and Pacific Select Distributors, LLC.

Pacific Life refers to Pacific Life Insurance Company and its subsidiary Pacific Life & Annuity Company. Insurance products can be issued in all states, except New York, by Pacific Life Insurance Company or Pacific Life & Annuity Company. Product/material availability and features may vary by state. Each insurance company is solely responsible for the financial obligations accruing under the products it issues. 

Variable insurance products are distributed by Pacific Select Distributors, LLC (member FINRA & SIPC), a subsidiary of Pacific Life Insurance Company and an affiliate of Pacific Life & Annuity Company. 

The home office for Pacific Life & Annuity Company is located in Phoenix, Arizona. The home office for Pacific Life Insurance Company is located in Omaha, Nebraska.

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