New York 8104 Template

New York 8104 Template

The New York 8104 form is a document used by policyholders to make changes regarding their life insurance dividends and tax withholding preferences. This form allows individuals to select how they wish to receive their dividends and manage any applicable tax withholdings. Understanding the options available on the 8104 form is essential for effective policy management and compliance with tax regulations.

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The New York 8104 form is an essential document for policyholders of New York Life Insurance Company and its affiliates, including NYLIFE Insurance Company of Arizona and New York Life and Annuity Corporation. This form primarily facilitates changes to dividend options associated with life insurance policies. Policyholders can select how they wish to manage their dividends, whether by applying them to premiums, accumulating them with interest, or opting for cash payments. Additionally, the form includes a section for electing income tax withholding, a crucial consideration for policyholders who may face tax implications from dividend withdrawals. Accurate completion of the form is vital, as it requires personal information such as the policy number, the owner's name, and Social Security or Tax ID numbers. Furthermore, policyholders must be mindful of deadlines for dividend option changes, which take effect on the policy anniversary date if submitted timely. Overall, the New York 8104 form plays a significant role in managing life insurance benefits and ensuring compliance with tax regulations.

Misconceptions

Misconception 1: The New York 8104 form is only for policy cancellations.

This is not true. While the form does allow for changes related to policy dividends, such as selecting a different dividend option, it is not limited to cancellations. It serves multiple purposes, including changing how dividends are applied or distributed.

Misconception 2: Completing the form guarantees that my dividend option change will take effect immediately.

In reality, any changes made will only take effect on the current policy anniversary date if the request is received at least 31 days prior. If submitted later, the change will apply to the next anniversary. Timing is crucial.

Misconception 3: I can ignore tax withholding when I withdraw dividends from my policy.

This is a risky assumption. The IRS mandates that if you do not provide a social security number or taxpayer identification number, a flat 10% will be withheld from the taxable gain. It is essential to understand the tax implications of any withdrawals.

Misconception 4: All states have the same tax withholding rules for policy withdrawals.

This is incorrect. Different states have varying requirements for tax withholding. Some states, like Iowa and Maryland, require state income tax withholding when federal tax is withheld. Always check your specific state’s rules to avoid surprises.

Misconception 5: I can change my withholding election anytime without any consequences.

While you can change your withholding election, it is important to note that the election applies to all future payments from the same policy. Additionally, if you do not withhold enough tax, you may face penalties under estimated tax payment rules. Careful consideration is needed.

Dos and Don'ts

When filling out the New York 8104 form, there are important steps to follow and common pitfalls to avoid. Here’s a helpful list of dos and don’ts:

  • Do provide accurate personal information, including your Social Security number or Tax ID.
  • Do check the appropriate boxes for your dividend option selections carefully.
  • Do ensure that your signature is present where required, as it is mandatory.
  • Do consult a tax advisor if you have questions about withholding options.
  • Don’t leave any required fields blank; incomplete forms can cause delays.
  • Don’t ignore the deadlines for submitting dividend option changes; they must be received at least 31 days before the policy anniversary.
  • Don’t forget to check for any specific state tax withholding requirements that may apply.

Similar forms

The New York 8104 form is a critical document related to life insurance policies, specifically concerning dividend options and tax withholding. Several other documents share similarities with the 8104 form in terms of purpose, content, or function. Below is a list of ten such documents, each with a brief explanation of how it relates to the New York 8104 form.

  • Form W-9: This form is used to provide taxpayer identification information to the IRS. Like the 8104 form, it requires the submission of a Social Security number or Tax ID, ensuring compliance with tax regulations.
  • Form W-4P: This document is utilized for withholding tax on pensions and annuities. Similar to the 8104, it allows individuals to specify how much tax should be withheld from their payments, helping manage tax liabilities effectively.
  • Form 1099: Issued by payers to report various types of income, this form is similar to the 8104 in that it deals with taxable gains from life insurance policies, ensuring that policyholders are aware of their tax obligations.
  • Form 1040: The standard individual income tax return form, which requires information about all income, including gains from life insurance dividends. Like the 8104, it emphasizes the importance of reporting income accurately.
  • State Tax Withholding Forms: Various states have their own forms for income tax withholding, similar to the withholding options on the 8104. These forms help residents manage state tax obligations related to insurance payouts.
  • Form 4506-T: This form allows individuals to request a transcript of their tax returns. It relates to the 8104 as both documents involve the verification of tax information for compliance purposes.
  • Policy Change Request Forms: These forms are used to request changes to insurance policies, such as beneficiary updates. Like the 8104, they require detailed information about the policyholder and can affect the policy's financial aspects.
  • Claim Forms: Used to file a claim on an insurance policy, these forms share similarities with the 8104 in that they require specific information about the policy and the insured, ensuring proper processing of claims.
  • Beneficiary Designation Forms: These forms allow policyholders to designate beneficiaries for their insurance policies. Like the 8104, they are essential for ensuring that financial benefits are distributed according to the policyholder's wishes.
  • Annual Statements: These documents provide a summary of the policy's performance and any dividends earned. They are similar to the 8104 as they inform policyholders about their financial standing and options regarding dividends.

Each of these documents plays a significant role in managing life insurance policies and ensuring compliance with tax regulations. Understanding their similarities with the New York 8104 form can help policyholders navigate their responsibilities and options more effectively.

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New York Life Insurance Company

NYLIFE Insurance Company of Arizona

New York Life and Annuity Corporation

(Not licensed in every state)

(A Delaware Corporation)

4343 North Scottsdale Rd, Suite 220

51 Madison Avenue, New York, NY 10010

Scottsdale, AZ 85251

www.newyorklife.com

 

Insured Information

Policy Number

Name

 

 

Policy Owner information

 

 

 

Name (if different than above)

Social Security */ TAX ID (Required)

 

 

Daytime Phone #

Email

 

 

Dividend Option Change

The dividend option change will become effective on the current policy anniversary date, if this request is received by New York Life at least 31 days prior to the current policy anniversary date. Any requests received after this period will take effect on the next policy anniversary.

Note: If your policy contains the Dividend Option Term rider, the dividend option must be Paid-up Additions. Whole Life Additions are only available for policies issued between issued between April 7, 1975 and February 1, 1988.

A.Policies With One Year Term Option (Select one box below)

Cancel the ONE YEAR TERM Rider and apply dividends payable as elected in Section B OR

Retain the ONE YEAR TERM Rider, but change the option for the balance of dividends payable, as elected below :

(Check one)

Provide Paid-Up Additions

Leave on deposit with New York Life to accumulate at interest

Apply to pay premium and any loan interest due; pay balance in cash*

Apply toward payment of premium only; pay balance in cash

Pay in cash

Provide Whole Life Additions

B.Policies Without One Year Term Option (Select one box below)

Provide Paid-Up Additions

Leave on deposit with New York Life to accumulate at interest

Apply to pay premium and any loan interest due; pay balance in cash*

Apply toward payment of premium only; pay balance in cash*

Pay in cash

Provide Whole Life Additions* (See note above)

Change the current dividend option to cash and apply the cash dividend proceeds to pay policy loan interest due, then repay any policy loan on this policy. When any loan interest which is due and any policy loan has been repaid, change the dividend method to provide Paid-up Additions. Any remaining cash dividend for the year in which this change occurs should be applied under that dividend method

*This dividend option is available only when the mode of payment is one that has a premium falling due on the policy anniversary date. This dividend option request also authorizes a change of mode to annual, if no other mode is selected, and/or the withdrawal or sufficient dividends to pay the balance of the premium due, if necessary.

I understand that any insurance provided by an Expanded Protection Benefit rider will terminate on the date immediately preceding the policy anniversary when the new dividend option takes effect.

8104 (6/2016) Page 1 of 3

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I wish to elect Added Value Advantage

Income Tax Withholding Section

IMPORTANT: The Internal Revenue Service (IRS) requires that you complete this section. See important tax information below before you make your withholding election. If your social security number (SSN) or taxpayer identification number (TIN) is not furnished, we are required by Federal law to withhold 10% of the taxable gain. Withholding election is not required for withdrawal from Dividend Deposits.

Are you a citizen of the United States (including a resident alien)? Yes

No

I elect to have the following withholding option applied to this payment and any future payment(s) under this policy (check only one box):

NO Federal or State Income taxes will be withheld

ONLY Federal Income taxes withheld

 

(This option may not be available for residents

 

of certain states. See the State Income Tax

 

Withholding section of this form)

BOTH Federal and State Income taxes will be withheld

ONLY State income taxes withheld

If you elected any of the option above in which taxes will be withheld, you can specify the tax withholding percentage(%) of each withdrawal you would like to have applied to Federal and/or State income tax withholding. If a specific tax withholding amount is not indicated below, we will withhold 10% for federal tax purposes and the state’s minimum withholding (if applicable). Please fill in items (1) and (2) below.

(1)I would like to apply _____% of the taxable portion to Federal Withholding.

(2)I would like to apply _____% of the taxable portion to State Withholding.

If you elect to have Federal Income tax withheld, we are required to withhold at least 10% of the taxable portion of the distribution. If your state requires withholding, we will withhold the state’s minimum amount if you select an amount that is less than the minimum. Please see Important State Income Tax Withholding Information section.

Policyowner’s Signature (REQUIRED)

Under penalties of perjury, I (as owner named) certify: (1) my social security number or Tax ID number shown on this form is my correct taxpayer identification number, (2) I am not subject to back withholding because (a) I am exempt from backup withholding; or (b) I have not been notified by the IRS that I am subject to backup withholding as a result of a failure to report all interest or dividend income; or (c) the IRS has notified me that I am no longer subject to backup withholding, (3) I am a U.S. person (includes a U.S. resident alien), and (4) I am exempt from Foreign Account Compliance Act (FATCA) reporting.

Check this box if the IRS has notified you that you are subject to backup withholding.

If I am not a U.S. citizen, U.S. resident alien or other U.S. person, I am submitting the applicable Form W8 with this form to certify my foreign status and if applicable, claim treaty benefits.

The Internal Revenue Service does not require your consent to any provision of this document other than the certifications required to avoid backup withholding.

X

 

Policy Owner Signature

Name (Printed)

Date

 

 

X

 

 

 

 

 

 

 

 

 

Policy Owner Signature

Name (Printed)

Date

 

 

RETURN FORM TO:

 

 

 

 

New York Life

 

 

 

 

P.O. Box 130539

 

 

 

 

Dallas, TX 75313-0539

 

 

 

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Important Tax Information

You should consider very carefully which box you check above. You should consult with your personal tax advisor, plan administrator, State income tax authority, or your local IRS office if you have any questions about income tax withholding. IRS publication 505 (Tax Withholding and Estimated Tax) and IRS forms W-9 and W-4P.

Federal Income Tax Withholding

A dividend withdrawal from your policy may result in a taxable gain reportable to the IRS on Form 1099. Federal income taxes must be withheld at a flat 10% rate from the taxable portion of your payment (as determined from our records), unless you elect not to have withholding apply by checking the appropriate box in the Income Tax Withholding Election section on this form. Non-persons such as corporations, companies, trusts, etc. or U.S. citizens living outside the United States cannot elect out of withholding. (Your election as to whether taxes are or are not to be withheld will apply to any other payments from the same policy. You may change your withholding election at any time.) In addition, a 10% IRS penalty may be imposed if you receive the withdrawal prior to age 59½, unless you are disabled or some other exception applies.

Even if you elect not to have Federal income tax withheld, you are liable for payment of such tax on the taxable portion of your payment. There are penalties under the estimated tax payment rules if enough tax has not been paid through either estimated tax payments or withholding. If the taxable portion of a payment when added to the taxable portion of all other payments during the year is less than $200, Federal income tax is not required to be withheld.

State Income Tax Withholding

In addition to the Federal income tax withholding requirements, some states require withholding on policy gains when federal income tax is withheld. As of January 1, 2012, the following states require state income tax withholding when federal income tax withholding is in effect: Iowa, Kansas, Maryland, Massachusetts, Nebraska, Oklahoma, and Virginia. If you live in Arkansas, California, Delaware, Georgia, Maine, North Carolina, Oregon, or Vermont we are required to withhold state income tax if federal income tax withholding is in effect, unless you elect not to have state income tax withheld. If you live in Michigan, we are required to withhold state income tax from the taxable portion of your payments, unless you provide us with a properly completed Form MI W-4P and you claim an exemption from withholding. Certain exceptions and special rules apply in some states. For more information regarding the withholding requirements applicable in your state, please consult your tax advisor or state tax authority.

If you reside in any of the following states and request state tax withholding, you must also specify the percentage of state tax withholding that you choose to apply to the taxable portion of the withdrawal: Alabama, Colorado, Connecticut, District of Columbia, Idaho, Illinois, Indiana, Kentucky, Louisiana, Minnesota, Missouri, Montana, New Jersey, New Mexico, New York, North Dakota, Ohio, South Carolina, Utah, West Virginia, and Wisconsin. In these states, if a percentage is not specified, state tax will not be

withheld.

8104 (6/2016) Page 3 of 3

Crucial Queries on This Form

What is the New York 8104 form?

The New York 8104 form is used by policyholders of New York Life Insurance Company to change their dividend options or to elect income tax withholding for distributions from their life insurance policies. This form allows you to specify how you want dividends to be applied, such as opting for paid-up additions or cash payments.

Who should fill out the 8104 form?

Any policyholder of a New York Life insurance policy who wishes to change their dividend option or needs to make a withholding election for tax purposes should complete this form. This includes individuals who own policies with one-year term options or those without.

What dividend options can I choose from on the form?

You can choose from several options for your dividends:

  • Provide Paid-Up Additions
  • Leave on deposit with New York Life to accumulate at interest
  • Apply to pay premium and any loan interest due; pay balance in cash
  • Apply toward payment of premium only; pay balance in cash
  • Pay in cash
  • Provide Whole Life Additions (subject to specific policy dates)

Make sure to select the option that best suits your financial needs.

When does the dividend option change take effect?

The change will become effective on your current policy anniversary date if New York Life receives your request at least 31 days prior to that date. If the request is submitted after this period, it will take effect on the next policy anniversary.

What are the tax implications of withdrawing dividends?

Withdrawing dividends may result in a taxable gain that must be reported to the IRS. Federal law mandates a 10% withholding on the taxable portion unless you elect otherwise. It's important to consult with a tax advisor to understand how this might affect your tax situation.

How do I elect for tax withholding on my dividends?

To elect tax withholding, you will need to complete the Income Tax Withholding section on the 8104 form. You can choose from various options, such as having no taxes withheld or specifying percentages for federal and state taxes. If you do not specify, the default withholding rates will apply.

What happens if I do not provide my Social Security Number or Tax ID?

If you do not provide your Social Security Number (SSN) or Tax Identification Number (TIN), federal law requires New York Life to withhold 10% of the taxable gain from your payment. This is to ensure compliance with tax regulations.

Can I change my withholding election later?

Yes, you can change your withholding election at any time. Just submit a new 8104 form with your updated preferences. It’s advisable to review your tax situation regularly and adjust your withholding as needed.

Where do I send the completed 8104 form?

Once you have filled out the 8104 form, return it to New York Life at the following address:

New York Life
P.O. Box 130539
Dallas, TX 75313-0539

How to Write New York 8104

Filling out the New York 8104 form is a straightforward process that requires careful attention to detail. By completing this form accurately, you can ensure that your requests regarding your life insurance policy are processed efficiently. Follow the steps below to fill out the form correctly.

  1. Gather your information: Before you begin, collect your policy number, your name, and the policy owner's information, including their Social Security number or Tax ID.
  2. Fill in the insured information: Enter the policy number and the name of the insured individual at the top of the form.
  3. Complete the policy owner information: If the policy owner is different from the insured, provide their name and Social Security number or Tax ID. Include a daytime phone number and email address for contact purposes.
  4. Select your dividend option: In Section A, choose your preferred option for policies with a One Year Term Rider or without it. Make sure to check the appropriate box based on your choice.
  5. Indicate your tax withholding preferences: In the Income Tax Withholding Section, indicate whether you want federal or state taxes withheld. Check the appropriate box and fill in the percentages if necessary.
  6. Sign the form: The policy owner must sign and date the form. This signature certifies the information provided is accurate and acknowledges any tax implications.
  7. Submit the form: Return the completed form to New York Life at the address provided on the form. Ensure you send it to the correct P.O. Box in Dallas, TX.

Once you have submitted the form, keep an eye out for any confirmation or follow-up communication from New York Life. This will help you ensure that your requests have been processed as intended.

Common mistakes

Completing the New York 8104 form can be a straightforward process, but there are common pitfalls that individuals often encounter. One frequent mistake involves the omission of essential personal information. When filling out the form, it is crucial to provide accurate details such as your name, policy number, and Social Security or Tax ID number. Neglecting to include this information can lead to delays in processing your request or even result in rejection of the form altogether.

Another common error arises from misunderstandings regarding the dividend options. The form presents various choices for how dividends should be managed, including options for paid-up additions and cash payments. Individuals sometimes select options without fully understanding their implications. It is vital to read the descriptions carefully and consider how each choice may affect your policy and its benefits in the long run.

Additionally, many people fail to adhere to the specific timelines outlined in the form. For instance, if a dividend option change request is not submitted at least 31 days prior to the current policy anniversary date, the change will not take effect until the following anniversary. This oversight can lead to unwanted delays in receiving benefits or adjustments to the policy.

Another mistake often seen is related to the tax withholding section. Some individuals do not realize that the Internal Revenue Service (IRS) mandates certain information to be filled out accurately. If your Social Security number or Tax ID is missing, the IRS requires a default withholding of 10% on taxable gains. This can lead to unexpected tax liabilities if not addressed properly. Ensure that you complete this section thoroughly to avoid unnecessary complications.

Moreover, individuals may overlook the requirement for signatures. The form explicitly states that the policy owner's signature is mandatory. Without it, the form is incomplete, and the request cannot be processed. This oversight can lead to frustration and delays, as individuals may have to start the process over again.

Lastly, many people do not consult their tax advisors when making decisions about withholding elections. The tax implications of your choices can be significant, and understanding them is essential. Failing to seek guidance can result in unexpected tax burdens or penalties. It is advisable to take the time to discuss your options with a professional to ensure that your selections align with your financial situation and goals.

Key takeaways

  • The New York 8104 form is essential for managing dividend options and tax withholding on your life insurance policy.

  • To ensure timely processing, submit your dividend option change request at least 31 days before your policy's anniversary date.

  • When selecting a dividend option, you can choose to apply dividends toward premiums, accumulate them with interest, or receive them in cash.

  • If your policy has a One Year Term rider, you must select how to handle dividends specifically for that rider.

  • Tax withholding is mandatory if you do not provide your Social Security Number or Tax ID; in this case, 10% will be withheld from your taxable gains.

  • There are different options for federal and state income tax withholding; carefully choose the option that fits your needs.

  • Consult with a tax advisor to understand the implications of your withholding choices and to ensure compliance with IRS regulations.

  • Remember, any changes made to your dividend options or tax withholding will affect future payments and may have tax consequences.

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Document Attributes

Fact Name Details
Form Number The form is identified as New York 8104.
Issuing Companies New York Life Insurance Company, NYLIFE Insurance Company of Arizona, and New York Life and Annuity Corporation.
Effective Date The dividend option change takes effect on the current policy anniversary date if received at least 31 days prior.
Dividend Options Options include Paid-Up Additions, cash payments, and leaving dividends on deposit.
Tax Withholding Requirement The IRS mandates completion of the tax withholding section for certain payments.
Federal Withholding Rate Federal income tax is withheld at a flat rate of 10% unless otherwise specified.
State Withholding Conditions States like Iowa, Kansas, and Virginia require state income tax withholding when federal tax is withheld.
Signature Requirement The policy owner's signature is required to certify information and avoid backup withholding.
Return Address Completed forms should be sent to New York Life, P.O. Box 130539, Dallas, TX 75313-0539.