New York Life Insurance and Annuity Corporation

New York Life Insurance and Annuity Corporation AARP Operations Claims Service P.O. Box 30713 Tampa, FL 33630-3713

Dear Beneficiary:

Please accept our condolences on your recent loss. We understand this is a difficult time, and we hope that we can alleviate any concerns you may have about your claim.

This special form is designated to help you complete your claim quickly and easily. Please return your signed Claim Form with a certified copy of the death certificate so we can complete the processing of your claim.

If you are also the beneficiary of any other insurance policy or annuity with New York Life Insurance Company or its affiliates that insure the deceased, you should contact those offices directly to file a claim.

New York Life Insurance and Annuity Corporation, issuer of the annuity product for the AARP Lifetime Income Program, takes pride in the speed with which we pay claims. Most payments on claims are sent to the beneficiaries within five business days from the date the Company receives the completed Claim Form and death certificate in its Claims office.

Please be assured the AARP Lifetime Income Program is committed to completing the processing of your claim quickly once we receive all the necessary information and documentation.

If you have any questions or need assistance, please feel free to contact our Claims Department at 1-800-590-1504, between the hours of 8am to 5pm Eastern Standard Time Monday through Friday.

Sincerely,

Matt Pittarelli Corporate Vice President, New York Life For the AARP Lifetime Income Program

REV20130607ACF

HOW TO COMPLETE YOUR CLAIM FORM

Please read this page before you start to complete your Claim Form

To complete the processing of your claim, we must have a fully completed Claim Form from each beneficiary, one certified death certificate and other documents as appropriate for the claim.

SECTION 1 Please be sure to enter all annuity contract numbers on the Claim Form. Please do not send the original contracts.

SECTION 2 Information about the deceased is necessary for purposes of identification.

authorized representative of that institution must sign the Claim Form.

If the Beneficiary is a Minor: If there is a legal guardian for a minor, the guardian should sign the Claim Form and submit a copy of the guardianship papers. If no legal guardian has been appointed, contact us for further information.

SECTION 4

Please sign the Claim Form in the same manner as you would normally sign your checks. Your signature will be used to verify instructions you give us in the future.

SECTION 3 Information about the Beneficiary is necessary for claims processing. Taxpayer Identification Number: The Federal government requires us, and all other financial institutions, to report the interest we pay you. Therefore, we are required to obtain your Social Security or other Taxpayer Identification Number, which you must certify under penalty of perjury. If you are applying for a tax number, please write "applied for" in the appropriate space. If you fail to supply us with an identification number, the Federal government requires us to withhold a specified percentage from the interest payments. You can claim the amount withheld as a credit on your tax return.

Some persons have been notified by the Internal Revenue Service that they are subject to "back-up withholding" because in the past they did not report all their interest or dividends. If you have been so notified, and a back-up withholding order has not been rescinded, you must cross out the statement right below your Social Security or Taxpayer Identification Number. We may contact you for more information if there are any questions about your Taxpayer Identification Number or back-up withholding status, or if you are a non-resident alien or foreign entity.

Claims by an Estate: If the claim is being filed by an Executor or Administrator, he or she must sign the Claim Form and submit a copy of the appointment papers. Be sure to use the Estate's tax number.

Assignments: If you have assigned all or any portion of the benefit to a funeral home for final expenses, please include that assignment. If the deceased assigned the contract to a bank or other financial institution, an

Please complete the attached W-4P ? Withholding Certificate for Pension or Annuity payments.

Please return the W-4P with your completed claim form. We will be required to withhold 10% of the taxable part of the payment if we have not received your election not to have income tax withheld by the time payment is made to you.

Fraud Statements

Arizona Fraud Warning

For your protection Arizona law requires the following to appear on this form. Any person who knowingly presents a false or fraudulent claim for payment of a loss is subject to criminal and civil penalties.

California Fraud Warning

For your protection California Law requires the following to appear on this form: any person who knowingly presents a false or fraudulent claim for the payment of a loss is guilty of a crime and may be subject to fines and confinement in state prison.

Colorado Fraud Warning

It is unlawful to knowingly provide false, incomplete or misleading facts or information to an insurance company for the purpose of defrauding or attempting to defraud the company. Penalties may include imprisonment, fines, denial of insurance and civil damages. Any insurance company or agent of an insurance company who knowingly provides false, incomplete, or misleading facts or information to a policyholder or claimant for the purpose of defrauding or attempting to defraud the policyholder or claimant with regard to a settlement or award payable from insurance proceeds shall be reported to the Colorado Division of Insurance within the Department of Regulatory Agencies.

District of Columbia & Rhode Island

Fraud Warning

Any person who knowingly presents a false or fraudulent claim for payment of a loss or benefit or knowingly presents false information in an application for insurance is guilty of a crime and may be subject to fines and confinement in prison.

Florida Fraud Warning

Any person who knowingly and with intent to injure, defraud, or deceive any insurer files a statement of claim or an application containing any false, incomplete, or misleading information is guilty of a felony of the third degree.

Maryland Fraud Warning

Any person who knowingly and willfully presents a false or fraudulent claim for payment of a loss or benefit or who knowingly and willfully presents false information in an application for insurance is guilty of a crime and may be subject to fines and may be subject to fines and confinement in prison.

New Jersey Fraud Warning

Any person who knowingly files a statement of claim containing any false or misleading information is subject to criminal and civil penalties.

Oregon Fraud Warning

Willfully falsifying material facts on an application or claim may subject you to criminal penalties.

Pennsylvania Fraud Warning

Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information or conceals for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties.

Puerto Rico Fraud Warning

Any person who knowingly and with the intention of defrauding presents false information in an insurance application, or presents, helps, or causes the presentation of a fraudulent claim for the payment of a loss or any other benefit, or presents more than one claim for the same damage or loss, shall incur a felony and, upon conviction, shall be sanctioned for each violation with the penalty of a fine of not less than five thousand dollars ($5,000) and not more than ten thousand dollars ($10,000), or a fixed term of imprisonment for three (3) years, or both penalties. If aggravating circumstances are present, the penalty thus established may be increased to a maximum of five (5) years, if extenuating circumstances are present, it may be reduced to a minimum of two (2) years.

Virginia Fraud Warning

It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties include imprisonment, fines and denial of insurance benefits.

Fraud Warning For All Other States

Any person who knowingly and with the intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime and subjects such person to criminal and civil penalties. Penalties may include imprisonment, fines, or a denial of insurance benefits if a person provides false information.

Claim Form

Please type or print legibly

Please return this Claim Form together with a certified copy of the death certificate and any other documentation required to: New York Life Ins. & Annuity Corp. AARP Lifetime Income Program/Claims Serv. PO Box 30713, Tampa, FL 33630-3713

1. Please list all annuity contract numbers for your claim.

2. Please tell us about the Deceased.

Name

First

Middle Initial

Last

State of Residence at Time of Death

Date of Death

Month

Day

Year

Date of Birth

Month Day Year

Place of Birth

State

Country

Cause of Death: Natural

Accident* Homicide*

* Please attach copies of police and coroner's report and any relevant news articles.

3. Please tell us about the Beneficiary

Suicide* Unknown Other

Name:

Sex:

Male

Female

Mailing

Address:

Street

City

State

Apartment No. Zip

Home Phone No: ( )

Business Phone No:

( )

Beneficiary Social Security or Taxpayer Identification Number

Date of Birth

/

/

Month

Day

Year

I have not been notified by the Internal Revenue Service that I am subject to back-up withholding as a result of failure to report all interest or dividends, or I am exempt. Cross out this statement if you have been notified.

In what capacity are you making this claim? Relationship to the Deceased:

Beneficiary Spouse

Executor Child

Trustee Grandchild

Assignee Parent

Other Other

4. Beneficiary Signature

? I certify that the Social Security or Taxpayer Identification Number and Back-up Withholding status information in Section 3 are correct. I also certify that I am a U.S. person, including a U.S. resident alien (non-US person must complete form W8BEN).

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

? I am exempt from the Foreign Account Tax Compliance Act (FATCA) reporting.

In addition, I have read and understand the Fraud Statement that is applicable to the state in which I reside. New York Residents: Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime, and shall also be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation.

Signature

Date

This Claim Form may have been sent before New York Life Insurance and Annuity Corporation has determined whether any annuity contract was in force under the AARP Lifetime Income Program at the time of death, and to whom the proceeds are payable. They retain their rights to make such determination.

W-4P Form

Department of the Treasury Internal Revenue Service

Withholding Certificate for Pension or Annuity Payments

OMB No. 1545-0074

2016

Purpose. Form W-4P is for U.S. citizens, resident aliens, or their estates who are recipients of pensions, annuities (including commercial annuities), and certain other deferred compensation. Use Form W-4P to tell payers the correct amount of federal income tax to withhold from your payment(s). You also may use Form W-4P to choose (a) not to have any federal income tax withheld from the payment (except for eligible rollover distributions or payments to U.S. citizens delivered outside the United States or its possessions) or (b) to have an additional amount of tax withheld.

Your options depend on whether the payment is periodic, nonperiodic, or an eligible rollover distribution, as explained on pages 3 and 4. Your previously filed Form W-4P will remain in effect if you do not file a Form W-4P for 2016.

What do I need to do? Complete lines A through G of the Personal Allowances Worksheet. Use the additional worksheets on page 2 to further adjust your withholding allowances for itemized deductions, adjustments to income, any additional standard deduction, certain credits, or multiple pensions/more-than-one-income situations. If you do not want any federal income tax withheld (see Purpose, earlier), you can skip the worksheets and go directly to the Form W-4P below.

Sign this form. Form W-4P is not valid unless you sign it.

Future developments. The IRS has created a page on for information about Form W-4P and its instructions, at w4p. Information about any future developments affecting Form W-4P (such as legislation enacted after we release it) will be posted on that page.

Personal Allowances Worksheet (Keep for your records.)

A Enter "1" for yourself if no one else can claim you as a dependent . . . . . . . . . . . . . . . .

A

B

{Enter "1" if:

? You are single and have only one pension; or ? You are married, have only one pension, and your spouse has no income subject to withholding; or

}...........

B

? Your income from a second pension or a job or your spouse's

pension or wages (or the total of all) is $1,500 or less.

C Enter "1" for your spouse. But, you may choose to enter "-0-" if you are married and have either a spouse who has

income subject to withholding or more than one source of income subject to withholding. (Entering "-0-" may help

you avoid having too little tax withheld.) . . . . . . . . . . . . . . . . . . . . . . . . .

C

D Enter number of dependents (other than your spouse or yourself) you will claim on your tax return . . . . .

D

E Enter "1" if you will file as head of household on your tax return . . . . . . . . . . . . . . . . .

E

F Child Tax Credit (including additional child tax credit). See Pub. 972, Child Tax Credit, for more information.

? If your total income will be less than $70,000 ($100,000 if married), enter "2" for each eligible child; then less "1" if

you have two to four eligible children or less "2" if you have five or more eligible children.

? If your total income will be between $70,000 and $84,000 ($100,000 and $119,000 if married), enter "1" for each

eligible child . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

F

G Add lines A through F and enter total here. (Note: This may be different from the number of exemptions you claim on your tax return.) a G

For accuracy, complete all

{ ? If you plan to itemize or claim adjustments to income and want to reduce your withholding, see the Deductions and Adjustments Worksheet on page 2. ? If you are single and have more than one source of income subject to withholding or are married and you and your spouse both have income subject to withholding and your

worksheets combined income from all sources exceeds $50,000 ($20,000 if married), see the Multiple

that apply.

Pensions/More-Than-One-Income Worksheet on page 2 to avoid having too little tax withheld.

? If neither of the above situations applies, stop here and enter the number from line G on line 2

of Form W-4P below.

Separate here and give Form W-4P to the payer of your pension or annuity. Keep the top part for your records.

W-4P Form

Department of the Treasury Internal Revenue Service

Your first name and middle initial

Withholding Certificate for Pension or Annuity Payments

a For Privacy Act and Paperwork Reduction Act Notice, see page 4. Last name

OMB No. 1545-0074

2016

Your social security number

Home address (number and street or rural route) City or town, state, and ZIP code

Claim or identification number (if any) of your pension or annuity contract

Complete the following applicable lines.

1 Check here if you do not want any federal income tax withheld from your pension or annuity. (Do not complete line 2 or 3.) a

2 Total number of allowances and marital status you are claiming for withholding from each periodic pension or

annuity payment. (You also may designate an additional dollar amount on line 3.) . . . . . . . . . . . a

Marital status:

Single

Married

Married, but withhold at higher Single rate.

(Enter number

of allowances.)

3 Additional amount, if any, you want withheld from each pension or annuity payment. (Note: For periodic payments,

you cannot enter an amount here without entering the number (including zero) of allowances on line 2.) . . . . a $

Your signature a

Cat. No. 10225T

Date a

Form W-4P (2016)

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