RMD - New York Life

Name. Title. Variable products are offered through properly licensed registered representatives of NYLIFE Securities Inc. (member NASD/SIPC), 51 Madison Avenue, New York, NY 10010. 2005 REQUIRED MINIMUM DISTRIBUTION ELECTION FORM. Date: Policy Number: XX XXX XXX Policyowner: FIRST NAME LAST NAME Social Security Number Cash Value as of 12/31/2004 ................
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