Fillable Printable Vba 29 1546 Are

Vba 29 1546 Are

APPLICATION FOR CASH SURRENDER

GOVERNMENT LIFE INSURANCE

OMB Control No. 2900-0012

Respondent Burden: 10 minutes

VA FORM

JUN 2007

29-1546

EXISTING STOCK OF VA FORM 29-1546, JUN 2005,

WILL BE USED.

1. FIRST-MIDDLE-LAST NAME (Type or print)

2. INSURANCE FILE NUMBER

NET OPTIONS: Dividend pays annual premium and remainder is used to reduce loan (NETLOLI), buy additional insurance (NETPUA), or refunded to veteran (NETCASH).

10. DATE

11. HOW WOULD YOU LIKE TO RECEIVE THIS PAYMENT?

BY DIRECT DEPOSIT (Please attach a voided personal check)

(NOTE: If you are currently on Direct Deposit, this will

stop all future payments by electronic transfer until we

receive instructions from you.)

ADDRESS SHOWN IN ITEM 3

QUESTIONS ABOUT YOUR INSURANCE? CALL US TOLL-FREE AT 1-800-669-8477.

NOTE: IF YOU PREFER, INSTEAD OF MAILING THIS FORM, IT MAY BE FAXED TO 1-888-748-5828

PLEASE DO NOT RETURN YOUR POLICY WITH THIS APPLICATION

IMPORTANT - After this form has been completed and signed, it should be mailed to:

Department of Veterans Affairs

P.O. Box 7327

Philadelphia, PA 19101

D. TELEPHONE NUMBER OF FINANCIAL

INSTITUTION

SAVINGS

I hereby surrender all my right, title and interest in the basic insurance policy and/or paid-up additions represented by the policy number shown in Item 4 for the purpose

of obtaining the cash surrender value.

4. POLICY NUMBER (Include letter prefix) 3. MAILING ADDRESS (Must be completed)

5. DAYTIME TELEPHONE NUMBER (Include Area Code)

A. NAME OF FINANCIAL INSTITUTION

6. SOCIAL SECURITY NUMBER

8. FUTURE DIVIDEND OPTION

7. I HEREBY SURRENDER MY: (Check appropriate box)

PARTIAL SURRENDER OF PAID-UP ADDITIONS (Amount of check) $

9. FULL SIGNATURE OF INSURED (Do not print)

BY CHECK

(NOTE: The account must be in the name of the veteran. Direct Deposit will continue with all

future payments to this account. You must notify us of any changes.)

E. ADDRESS OF FINANCIAL INSTITUTION F. TYPE OF DEPOSITOR ACCOUNT

B. TRANSIT/ROUTING NUMBER

TEMPORARY ADDRESS SHOWN BELOW

(Please print)

C. DEPOSITOR ACCOUNT NUMBER

BASIC INSURANCE POLICY

BASIC INSURANCE AND PAID-UP ADDITIONS

USE SURRENDER VALUE TO BUY REDUCED PAID-UP INSURANCE

APPLY TO PAY PREMIUMS IN ADVANCE

APPLY TO BUY PAID-UP ADDITIONS

PAID-UP ADDITIONS ONLY

NETLOLI

HOLD ON DIVIDEND CREDIT

HOLD ON DIVIDEND DEPOSIT

NETPUA

PAY TO ME IN CASH

APPLY TO PAY INDEBTEDNESS

NET CASH

CHECKING

PRIVACY ACT NOTICE: The VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of 1974 or Title 5,

Code of Federal Regulations 1.576 for routine uses identified in the VA system of records, 36VA00, Veterans and Armed Forces Personnel U.S. Government Life Insurance

Records-VA, published in the Federal Register. Your obligation to respond is voluntary, but your failure to provide us the information could impede processing. Giving us your

SSN account information is voluntary. Refusal to provide your SSN by itself will not result in the denial of benefits. The VA will not deny an individual benefits for refusing to

provide his or her SSN unless the disclosure of the SSN is required by a Federal Statute of law in effect prior to January 1, 1975, and still in effect. The responses you submit

are considered confidential (38 U.S.C. 5701).

RESPONDENT BURDEN: We need this information to determine, establish, or verify your eligibility for VA Insurance benefits (38 U.S.C. 5902). Title 38 United States Code,

allows us to ask for this information. We estimate that you will need an average of 10 minutes to review the instructions, find the information, and complete this form. VA cannot

conduct or sponsor a collection of information unless a valid OMB control number is displayed. You are not required to respond to a collection of information if this number is not

displayed. Valid OMB control numbers can be located on the OMB Internet page at www.whitehouse.gov/library/OMBINV.VA.EPA. html#VA. If desired, you can call

1-800-827-1000 to get information on where to send comments or suggestions about this form.

APPLICATION FOR POLICY LOAN

GOVERNMENT LIFE INSURANCE

OMB Approved No. 2900-0012

Respondent Burden: 10 minutes

1. FIRST-MIDDLE-LAST NAME (Type or print)

IMPORTANT NOTICE

MAXIMUM LOAN

All new policy loans have a variable interest rate with a minimum rate of 5% and a maximum rate of

12%. The interest rate may change October of each year. The rate is based on the interest for long term

Treasury bonds. Interest is payable yearly on the anniversary date of the loan.

10. DATE

11. HOW WOULD YOU LIKE TO RECEIVE THIS PAYMENT?

BY DIRECT DEPOSIT (Please attach a voided personal check)

(NOTE: If you are currently on Direct Deposit, this will

stop all future payments by electronic transfer until we

receive instructions from you.)

ADDRESS SHOWN IN ITEM 3

VA FORM

JUN 2007

29-1546

QUESTIONS ABOUT YOUR INSURANCE? CALL US TOLL-FREE AT 1-800-669-8477.

EXISTING STOCK OF VA FORM 29-1546, JUN 2005,

WILL BE USED.

NOTE: IF YOU PREFER, INSTEAD OF MAILING THIS FORM, IT MAY BE FAXED TO 1-888-748-5828

PLEASE DO NOT RETURN YOUR POLICY WITH THIS APPLICATION

IMPORTANT - After this form has been completed and signed, it should be mailed to:

Department of Veterans Affairs

P.O. Box 7327

Philadelphia, PA 19101

D. TELEPHONE NUMBER OF FINANCIAL

INSTITUTION

SAVINGS

APPLY EXISTING DIVIDEND CREDIT/DEPOSIT TO REDUCE THE LOAN

PRINCIPAL

NOTE: Your VA compensation or pension or military retirement pay may be used to repay your loan. For more information, call the toll-free number below.

2. INSURANCE FILE NUMBER

3. MAILING ADDRESS (Must be completed)

5. DAYTIME TELEPHONE NUMBER (Include Area Code)

A. NAME OF FINANCIAL INSTITUTION

7. AMOUNT OF LOAN DESIRED (Check one)

4. SOCIAL SECURITY NUMBER

8. DO YOU WISH TO USE DIVIDENDS TO REDUCE THE LOAN?

6. POLICY NUMBER(S) ON WHICH LOAN IS REQUESTED

APPLY FUTURE DIVIDENDS TO REDUCE LOAN PRINCIPAL

APPLY FUTURE DIVIDENDS TO PAY AN ANNUAL PREMIUM WITH THE

REMAINING BALANCE APPLIED TO REDUCE THE LOAN

9. FULL SIGNATURE OF INSURED (Do not print)

BY CHECK

(NOTE: The account must be in the name of the veteran. Direct Deposit will continue with all

future payments to this account. You must notify us of any changes.)

E. ADDRESS OF FINANCIAL INSTITUTION F. TYPE OF DEPOSITOR ACCOUNT

B. TRANSIT/ROUTING NUMBER

TEMPORARY ADDRESS SHOWN BELOW

(Please print)

C. DEPOSITOR ACCOUNT NUMBER

CHECKING

(AMOUNT) OR