Client Assistance:

Client Assistance Forms

Introduction

At Columbus Life, the goal of the Client Services Department is to give the best service possible to our agents and policyowners. To meet this goal, forms are simple and easy to use and kept to a minimum. Agents are made aware of policy transactions.

In addition, all items processed are monitored to ensure prompt handling. Service requests are approached with a pleasant and positive attitude.

Because some of the transactions handled in the New Business Department, Agency Department and the Client Services Department are closely related, some transactions will also be covered in other areas of Marketing Manual Online. However, to ensure the best possible policyowner service, refer to the information and instructions contained in this section before submitting items for processing. If you have questions pertaining to service, contact Client Services at 800-677-9696.

Service Forms

CL 5.123—Payroll Deduction Authorization

Used by the insured to notify the employer when establishing payroll deduction to pay premiums.

CL 5.170—Time Saver

Used by both the Home Office and Field Force for brief messages.

CL 30.2—Tobacco Use Declaration

Used when changing to nonsmoker classification after attainment of age 20. Note that this form is state specific for New Jersey.

CL 35.47—PAT Bank Authorization Form

Must accompany check to establish a new PAT account or change banks.

CL 45.98—Policy Change Application - No Evidence Required

Used to make various policy changes including additions and deletions of benefits, adding Nonsmoker Discount, and changes in face amount or specified amount, when evidence of insurability is not required. Note there are state specific versions required in certain states.

CL 45.926—IUL Change Premium Allocation, Transfer Request or Telephone Authorization

Used to request change to Indexed Explorer Plus change to Premium Allocation, Reallocation, Dollar Cost Averaging, Transfer Request or Telephone Transaction Authorization.

CL 45.99—Policy Change Application - Requiring Evidence

Used to make various changes including additions and deletions of benefits, adding Nonsmoker Discount, and changes in the face amount or specified amount, when evidence of insurability is required.

CL 70.23—Selecting a Settlement Option

Used by policyowner and/or beneficiaries to direct payment of funds under a Settlement Option.

CL 70.400-ANN (annuity); CL70.400-TRM (term); CL 70.400-UL (UL); CL 70.400-WL (whole life)—Collateral Assignment & Release of Assignment Forms

Used to assign policy benefits to a third party. Select the collateral assignment based on the client’s product type. For convenience, we have now combined both the collateral assignment and release of assignment into one form.

CL 45.300—Application for Life Insurance (state specific), Including Version for Interstate Compact

Used by insured to provide health information when applying for reinstatement of life policy.

CL 70.57—General Services

Use when changing the owner of an existing policy and for other general updates to a policy.

CL 70.58—Policyowner's Election of Settlement Option

Used to change the beneficiary designation to provide for payment of death benefit under Settlement Option.

CL 70.84—Request for Change of Beneficiary

Used to change the beneficiary designation on life policies and annuity contracts. This is a two-sided form and care should be taken to be sure the correct side is completed. Refer to Side B for instructions for completing this form.

CL 75.32—Insured’s Statement of Business Expense

Guidelines to establish an Account Bill Plan.

CL 70.144—Request for Surrender/Withdrawal/Transfer/Loan

Used for all withdrawals of values from a non-qualified policy or contract in force with Columbus Life. The form includes a section where the tax identification number can be certified and a withholding election can be made. Note: there are several state specific versions and if the policy is a VUL policy, there is a VUL specific form that contains specific information on variable issues.

CL 70.197—Request for Withdrawal Arrangement

Used to establish monthly or quarterly income payments from Annuities. See Terms and Conditions on back of form.

CL 70.198—Withholding Notice and Election

Used to select a withholding option when owners have a gain at maturity, a gain on annuity death claims, a gain in other withdrawal arrangements, or have taxable amounts on payments from tax qualified contracts.

CL 70.209—Request for Annuity Withdrawal/Surrender

Used for any request involving IRA contributions; required for all types of IRA transfers, rollovers and withdrawals.

CL 80.119—Supplementary Report

Used for current condition for continuation of disability benefits as requested by the Home Office. To be completed by both policyowner and physician.

CL 70.239—Request for Dividend/PDF/PDP Transfer

Use when requesting withdrawal from Dividend/PDF/PDP.

CL 70.256A—Community Property Disclaimer

Use when submitting beneficiary changes for policyowners living in Community Property States.

CL 70.279—Contestable Claims

Sent to beneficiary when a death claim is being contested.

CL 70.290—Waiver of Surrender Charge Claim–Statement of the Insured

Used by insured to give consent for Columbus Life to seek information on health & medical history.

CL 70.66—403(b) Tax–Sheltered Annuity Loan Agreement

Used to request a loan on 403(b) plan.

CL 70.405—Authorization to Release Information

Used to authorize third parties to receive information on a policy.

Tax Forms

CL 5.601B—Tax Qualified Plan Questionnaire

Used to confirm plan provisions or changes for qualified 401 plans, 403(b) plans or any plan where 5500 reporting information or PS58 economic benefit information is required.

CL 70.40—Sole Proprietor/Partnership/Corporate Plan

Required for all ownership changes and distribution requests for all plans established under IRC Section 401.

CL 70.295—Request Form for Roth IRA

Used for Roth IRA requests; required for IRA transfers, rollovers and withdrawals.

CL 70.271—403(b) Tax Sheltered Annuity

Required for all types of 403(b) transfers, withdrawals and to establish a new or add to an existing plan.

CL 70.307—Simplified Employee Pension (SEP)

Required for SEP transfers, rollovers and withdrawals.

Tax Reporting

1099-INT—Interest Income

Used for reporting interest amounts of $10 or more; copy to the taxpayer by January 31.

1099-MISC—Miscellaneous Income

Used for reporting commission payments, miscellaneous service payments, doctor/medical service payments, etc.; copy to the taxpayer by January 31.

1099-R—Distributions from Pensions, Annuities, Retirement or Profit-Sharing Plans, IRA, Insurance Contracts, etc.

Used for reporting distributions from tax qualified and nonqualified life insurance policies and annuity contracts. Copy to the taxpayer by January 31.

5498—Individual Retirement Arrangement Information

Used to report regular and rollover contributions to and fair market value of IRA's; fair market value of SEP's; copy to the taxpayer and the IRS by May 31.

W-4P—Withholding Certificate for Periodic Payment

Election of amount of Federal Income Tax Withholding on payments from Settlement Contracts; submitted by recipient to the Home Office.

W-9—Taxpayer Identification Number Certification

Required to prevent "backup withholding" due to noncertified Social Security or Employer ID number at payment of reportable income; submitted by recipient to the Home Office.

Additional Reporting

IRA Statement

Sent to IRA participants by January 31. Provides December 31 Fair Market Value of contract as required by IRS.

5500 plan reporting

Information for qualified 401 plans and 403(b) TSA plans is created by the Home Office at plan anniversary and mailed to the plan owners and agents.

W-2 PS-58 reporting

Information for split dollar and qualified 401 and 403(b) plans is created after the end of the calendar year by the Home Office and provided to agents and some clients before January 31.

Annual Statements

Statement of fund balances for Universal Life policies and Deferred Annuity contracts are mailed to policyowners once each year near the anniversary date of the contract. Copies of the statements are automatically mailed to the agent. Statements are also available at other times upon request.

Click here to view a sample annual report for a Universal Life 820 $100,000 policy with Death Benefit Option 1 and a $10,000 adjustable life rider.