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Inforce   Licensing   Contracting   Commissions
Annuitizations   Claims  

Inforce
Form Number Form Name Description of Form
ZA-8154 Collateral Assignment Form Use when assigning the contract to cover a loan (i.e. bank loan)
ZA-8176 Pre-Authorized Checking Agreement Use when establishing an automatic premium withdrawal from a checking account.
ZA-8623 Participant Loan Agreement Use to set up a loan.
ZA-8635 Systematic Distribution Form Use to set-up an automatic distribution from an annuity.
ZA-8641 Financial Transaction IRA/Non-Qualified Form Use when taking a partial or full withdrawal from an IRA or non-qualified annuity.
ZA-8642 Financial Transaction 403(b)/TSA or 401(k) Form Use when taking a partial or full withdrawal from a 403(b)/TSA or 401(k) annuity.
ZA-8656 Systematic Transfer Form Use when establishing a dollar cost averaging or asset rebalancing program.
ZA-8658 Fund Transfer/Allocation Change Form Use when transferring existing funds or changing future allocations.
ZA-6033 Telephone Transfer Authorization Use when authorizing transfers by the phone on your account.
ZA-1025 Non-Financial Change Form Use when changing address, name, maturity date, beneficiaries or owners.
ZA-1068 Trustee Certification Required with ZA-1025 if ownership is changing to a trust.
ZA-1105 Disability Certification Use if exercising the Disability Rider.
ZA-1329 Guaranteed Retirement Income Benefit (GRIB) Cancellation Form Use when canceling the GRIB benefit.
ZA-1043 Required Distribution Election Form Use when taking distributions after age 70 1/2.
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Licensing
Form Number Form Name Description of Form
ZA-8219 Representative Application Use when requesting appointment with Zurich American Life Insurance Company.
ZA-1087 Agent of Record Change form Use to execute a Broker Dealer change.
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Contracting
Form Number Form Name Description of Form
ZA-8321 Net Compensation Amendment  
ZA-8247 Broker/Dealer Commission Election Form  
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Commissions
Form Number Form Name Description of Form
ZA-COM-DD Commission Direct Deposit Request Form Optional.  Submit for firm to receive commissions via EFT to checking or savings account.
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Annuitizations
Form Number Form Name Description of Form
ZA-7008 Fixed Annuity Income Plan Option Form Use when requesting a fixed annuity income plan be established.
ZA-9000 Guaranteed Retirement Income Benefit Annuity Income Option Form Use when electing the Guaranteed Retirement Income Benefit Option.
ZA-9001 GRIB Commutable Annuitization Option Form Use when requesting commutation of existing payments under the terms of the Guaranteed Retirement Income Benefit Option.
ZA-9003 GRIB - Helpful Hints Information regarding the Guaranteed Retirement Income Benefit process.
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Claims
Form Number Form Name Description of Form
ZA-1004 Death Packet Form Use when requesting death benefit proceeds.
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