Mass Mutual Policy Surrender – Fill Out and Use This PDF

Mass Mutual Policy Surrender is a way for people who are not sure about whether or not to purchase an insurance policy.

You've come to the perfect place if you're looking for this form. Our PDF editor is an online app that allows you to easily prepare any PDF. You can use any system - mobile phone, tablet, or laptop.

Mass Mutual Policy Surrender PDF Details

If you have a Mass Mutual life insurance policy, then you may be wondering what to do if you decide to surrender it. It's important to understand the process for surrendering a policy so that you can make the best decision for yourself and your family. The Mass Mutual Policy Surrender Form is a document that outlines the steps involved in surrendering a life insurance policy. In this article, we'll provide an overview of the information contained in the form, so that you can better understand what to expect if you choose to surrender your policy.

Listed here, you will discover quite a few details about mass mutual policy surrender PDF. Our recommendation is that you look at this material before you decide to start working with the form.

Question	Answer
Form Name	Mass Mutual Policy Surrender
Form Length	4 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	1 min
Other names	mass mutual whole life surrender form, massmutual whole life full surrender form, massmutual life insurance surrender form, mass mutual cash surrender form

Form Preview Example

Massachusetts Mutual Life Insurance Company and affiliates, Springfield MA 01111-0001

www.massmutual.com

Request to Pay Dividends, Surrender Additional Benefits Rider or Flexible Term Rider, or Change Dividend Option

Not for use with Qualified Plan or

Keogh (H.R. 10) Plan owned policies

Policy Information

Policy Number(s):	_________________________________________________________
Insured(s) Name(s):	_________________________________________________________
Owner(s) Name(s):	_________________________________________________________
Owner’s address:	PO Box, Apt #, Street:	_____________________________________
Check here if this is a new address	City, State ZIP:	_____________________________________

Owner’s daytime phone number: _________________________________________________________

Owner’s email address: _________________________________________________________

Withdraw or Apply Dividends

Withdraw dividends from:
Maximum Amount	or Specified Amount
Withdraw Accumulated Dividends	$___________________
Surrender Dividend Additions	$___________________
Surrender Additional Benefit Rider for net cash of	$____________________
Surrender Flexible Term Rider	A partial surrender is not allowed

In conjunction with the above withdrawal surrender, pay or apply dividends as follows:

	$_______________	To Premium	On Policy _________________________
	$_______________	To Loan Principal	On Policy_________________________
	$_______________	To Loan Interest	On Policy _________________________
	Automatic Premium Loan (APL) any balance due for premium and/or loan interest.
	To a Loan Payoff*		On Policy _________________________
*The loan payoff will be determined as of the date this form is received at our Home Office, in good order.
WARNING:	If any portion of the payment is taxable, an IRS Form 1099 (if required) will be issued to the
	owner of this policy regardless of whether surrender/withdrawal proceeds are payable to a

third party. Any additional tax reporting required to be made to a third party is the responsibility of the owner.

Page 1 of 4

Return this page to MassMutual

F6367 1211

Policy Number(s): ___________________________

Name(s) of Insured(s): _______________________

Request to Pay Dividends, Surrender Additional Benefits Rider or Flexible Term Rider, or Change Dividend Option

Not for use with Qualified Plan or Keogh (H.R. 10) Plans owned policies

Changes

Cancel Additional Benefits Rider premium as of the current paid to date (to be used in conjunction with the above surrender, and only in those instances where premiums for the Additional Benefits Rider are still being paid).

Cancel the one-year term agreement as of the next policy anniversary

Change the Dividend Option to:

Pay dividends in cash

Apply dividend to premium (this option is not available for policies that are paid monthly)

Accumulate dividends at interest

Purchase paid-up additions – future dividends (this option is not available on Term policies)

Cancel the Modified Payment Option (MPO)

Withholding Election and Required Notice

The distributions you receive from this policy are subject to Federal Income Tax withholding unless you elect not to have withholding apply. Withholding will apply only to the portion of your distribution that is includable in your income. If you elect no withholding or if you do not have enough withheld, you may be responsible for payment of estimated tax, and you may incur penalties if your withholding and estimated tax payments are not sufficient. If no election is made, any applicable taxes will be withheld. If taxes are withheld, receipt of your payment may be delayed by the calculations required.

NOTE! If you elect Federal Income Tax withholding, you are also electing State Income Tax withholding if applicable under relevant State law.

I have read the above notice regarding Federal Income Tax withholding and:

I do not want Federal Income Tax withheld from my payment.

I want Federal Income Tax withheld from my payment.

MEC WARNING: If your policy has been designated a Modified Endowment Contract (MEC), and you are under age 59 ½, any taxable gain may be subject to a 10% tax penalty. Please consult your tax advisor.

5Payee/Mailing Address

This section must be completed if the proceeds are to be made payable to and mailed to someone other than the policy owner at the address of record. Notary Public stamp may

apply, see Page2. .Exception: proceeds will only be payable to the trust itself on a trust-owned policy.

Payee Name:	___________________________
Payee Address:	___________________________
Payee Address:	___________________________
City, State, Zip:	___________________________

Distributions may not be sent to an agent/broker address.

6Delivery Options

Checks are mailed through the U.S. Postal Service First Class Mail unless otherwise requested.

U.S Postal Service - Mail (No charge – please allow 10 business days for normal delivery)

UPS Priority (The carrier charges a fee and cannot ship to a P.O. Box. Please provide the information requested below. If not provided, your surrender check will be mailed through the regular U.S. Postal Service.)

UPS Account Name__________________________

UPS Account Number ________________________

Zip Code associated with account # ____________

	Page 2 of 4	F6367 1211
	Return this page to MassMutual	F6367 1211
	Return this page to MassMutual

		Request to Pay Dividends, Surrender
	Policy Number(s): _____________________________	Additional Benefits Rider or Flexible
	Policy Number(s): _____________________________	Term Rider, or Change Dividend Option
		Term Rider, or Change Dividend Option

Name(s) of Insured(s): _________________________

Not for use with Qualified Plan or Keogh (H.R. 10) Plans owned policies

7 Owner Tax ID Required Please enter your TAX ID (SSN or EIN as applicable)

Check one:

SSN

EIN

Under penalties of perjury, I certify that the above is my correct Taxpayer Identification Number, and I am a U.S. person (U.S. citizen or resident alien), and the Internal Revenue Service (IRS) has NOT notified me that I am subject to backup withholding. The IRS does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.

8Individual, Joint or Multiple Owners Signature Section (All owners must sign.)

______________________________	_____________________________________________________	_______________
Printed Name of Owner	Signature of Owner	Date Signed
______________________________	_____________________________________________________	_______________
Printed Name of Additional Owner	Signature of Additional Owner	Date Signed
______________________________	_____________________________________________________	_______________
Printed Name of Additional Owner	Signature of Additional Owner	Date Signed

9Corporate, Partnership or Trust Owned Signature Section

________________________________________________________________________________			________________
Printed Name of Corporation, Partnership or Trust			Date of Trust
	I am the sole officer of the corporation listed
____________________________________	__________________________________	___________	________________
Printed Name of Corporate Officer or Trustee	Signature of Corporate Officer or Trustee	Title	Date Signed
____________________________________	__________________________________	____________	________________
Printed Name of Corporate Officer or Trustee	Signature of Corporate Office or Trustee	Title	Date Signed

10	Assignee Signature Section
______________________________		_____________________________________________	________________
Printed Name of Assignee		Signature & Title	Date Signed
______________________________		_____________________________________________	________________
Printed Name of Additional Assignee		Signature & Title	Date Signed

11	Notary Public Stamp (if applicable)

A Notary Public stamp is required for distributions greater than $50,000 only if in conjunction with one of the following:

•Checks are made payable to someone other than the policy owner, or

•Proceeds are sent to an address other than the address of record, or

•Proceeds are sent to an address that has been changed in the past 30 days A Notary Public stamp can be obtained from most banks or credit unions.

Subscribed and sworn to before me this ______________________ day of _______________________________

______________________________________________________________________________________________

Signature of Notary Public (Official stamp/seal required)

My commission expires

Page 3 of 4

Return this page to MassMutual

F6367 1211

12 Signature Instructions

The following descriptions explain the signature requirements for each type of ownership arrangement.

Corporation, partnership,	Include the full name of the corporation. Print or type the full name and corporate title of each
limited partnership	officer who signs. If the officer is the insured or a family member, we require the signature of
	another officer who is not related or, if all officers are related, the signature of two officers. If
	the insured is the only officer, we require one of the following: check the box titled Sole
	Officer in the signature section or a letter on company stationary to that effect or the
	insured’s signature with the corporate seal affixed. EXAMPLE - John Doe,
	President/Partner/General Partner, ABC Corporation
Trust **	Those trustees required to sign under the trust agreement. Include the full name of the trust,
	the date of the trust agreement and the title(s) of the officer(s), if corporate trust, signing.
	EXAMPLE – Mary Smith as Trustee under the ABC Trust Agreement dated mm/dd/yyyy
Custodian	• In all states except South Carolina and Vermont, include the full name of the
	custodian “as custodian for (insert name of minor) under the (name of state)’s
	UTMA.” EXAMPLE –Joan Doe as custodian for Alice Doe under the Massachusetts
	UTMA.
	• In South Carolina and Vermont, include the name of the custodian “as custodian for
	(insert name of minor) under the (name of state)’s UGMA.” EXAMPLE –Joan Doe
	as custodian for Alice Doe under the Vermont UGMA.
Executor**	Include the full name of the appointed executor, administrator, or personal representative, as
	“executor, administrator, or personal representative (list only one capacity) for the estate of
	(insert name of deceased), deceased.” If not previously submitted, a copy of the death
	certificate is required. EXAMPLE – Joan Doe, executor for the estate of Sam Doe,
	deceased.
Legal Guardian	Include the full name of the legal guardian/conservator, “as guardian/conservator of the
/Conservator**	estate of (insert name of person affected).” EXAMPLE – Joan Doe as Guardian/Conservator
	of the Estate of Sam Doe.
Attorney-in-Fact** (Power	Include the full name of the attorney-in-fact as “Attorney-in-Fact for (insert name of
of Attorney)	person).”EXAMPLE – Joan Doe, Attorney-in-Fact for Sam Doe.
If the policy is assigned	The owner and assignee must sign. Include the full name of the assignee. If the assignee is
	a corporation, also include the title(s) of all officer(s) signing. NOTE: If the right being
	exercised is granted to the assignee, only the assignee’s signature is required.

** Copies of the legal document that established authority must be submitted with this form unless already on file.

13 Customer Service Information

Once you have reviewed and completed this form, please return pages 1-3 for processing. To submit your request, please mail or fax this to:

Mail to:
MassMutual Financial Group	MassMutual Customer Service Center:	Internet Service
Enterprise Document Management Hub	1-800-272-2216	Connection:
1295 State Street	Monday through Friday, 8 a.m. – 8 p.m.	www.massmutual.com
Springfield MA 01111-0001	Eastern Time
Fax to:
Attention Life Hub
1-866-329-4527
	Page 4 of 4
	Retain this page for your records

F6367 1211

How to Edit Mass Mutual Policy Surrender Online for Free

Having the purpose of making it as quick to apply as it can be, we made our PDF editor. The entire process of filling the mass mutual cash surrender form can be straightforward in case you keep to the following actions.

Step 1: Choose the "Get Form Here" button.

Step 2: Now you are on the form editing page. You may edit, add content, highlight certain words or phrases, put crosses or checks, and put images.

Create the mass mutual cash surrender form PDF by typing in the text needed for each individual section.

portion of fields in mass mutual whole life surrender form

In the To Premium On Policy, To Loan Principal On Policy, To Loan Interest On Policy, Automatic Premium Loan APL any, To a Loan Payoff, On Policy, The loan payoff will be determined, WARNING, If any portion of the payment is, and Page of Return this page to field, write down the information you have.

mass mutual whole life surrender form To Premium On Policy, To Loan Principal On Policy, To Loan Interest On Policy, Automatic Premium Loan APL any, To a Loan Payoff, On Policy, The loan payoff will be determined, WARNING, If any portion of the payment is, and Page of Return this page to blanks to insert

The software will request data to easily submit the section Policy Numbers, Names of Insureds, Changes, Request to Pay Dividends Surrender, Cancel Additional Benefits Rider, Cancel the oneyear term agreement, Change the Dividend Option to, Pay dividends in cash, Apply dividend to premium this, Accumulate dividends at interest, Purchase paidup additions future, and Cancel the Modified Payment Option.

stage 3 to entering details in mass mutual whole life surrender form

Please be sure to describe the rights and responsibilities of the sides inside the I have read the above notice, I do not want Federal Income Tax, I want Federal Income Tax withheld, MEC WARNING If your policy has, PayeeMailing Address, This section must be completed if, Payee Name, Payee Address, Payee Address, City State Zip, Distributions may not be sent to, Delivery Options, Checks are mailed through the US, Class Mail unless otherwise, and business days for normal delivery section.

Entering details in mass mutual whole life surrender form step 4

End by reviewing all of these sections and filling out the relevant particulars: Policy Numbers, Names of Insureds, Request to Pay Dividends Surrender, Owner Tax ID Required Please, Check one, SSN, EIN, Under penalties of perjury I, Individual Joint or Multiple, Printed Name of Owner, Signature of Owner, Date Signed, Printed Name of Additional Owner, Signature of Additional Owner, and Date Signed.

Filling in mass mutual whole life surrender form stage 5

Step 3: When you have selected the Done button, your file is going to be accessible for export to any kind of device or email address you specify.

Step 4: Make copies of the form - it may help you refrain from upcoming challenges. And don't be concerned - we don't disclose or check your data.

Mass Mutual Policy Surrender – Fill Out and Use This PDF

Mass Mutual Policy Surrender PDF Details

Form Preview Example

How to Edit Mass Mutual Policy Surrender Online for Free

Watch Mass Mutual Policy Surrender Video Instruction

Mass Mutual Policy Surrender isn’t the one you’re looking for?

Please rate Mass Mutual Policy Surrender

Mass Mutual Policy Surrender – Fill Out and Use This PDF

Mass Mutual Policy Surrender PDF Details

Form Preview Example

How to Edit Mass Mutual Policy Surrender Online for Free

Watch Mass Mutual Policy Surrender Video Instruction

Mass Mutual Policy Surrender isn’t the one you’re looking for?

Related Documents

Please rate Mass Mutual Policy Surrender

Related Resources