RELEASE OF ASSIGNMENT

New York Life Insurance Company New York Life Insurance and Annuity Corporation (A Delaware Corporation) 51 Madison Avenue, New York, New York 10010 NYLIFE Insurance Company of Arizona (Not licensed in every state) 4343 North Scottsdale Road, Suite 220, Scottsdale, AZ 85251

RELEASE OF ASSIGNMENT

PLEASE READ THE FOLLOWING INSTRUCTIONS BEFORE COMPLETING THIS FORM.

Releases of assignments of policies issued by the Company or Corporation must be made in duplicate. We will retain one copy and the other will be returned.

Executor or Administrator When an executor or administrator executes a release of assignment it should be accompanied by an official certificate certifying that such executor or administrator is still acting in such capacity.

Corporations A release of assignment by a Corporation must be signed by two Corporate Officers on behalf of the Corporation; one such officer may be either the Treasurer or Secretary of the Corporation.

Signature by Mark If a person executing a release of assignment cannot write and signs with a mark, two witnesses must witness the signature.

RETURN FORM TO:

For Variable Life and Variable Annuity policies:

New York Life, Variable Products Service Center

Madison Square Station, PO Box 922, New York, NY 10159

For all other policies:

If You Live In: AL, CT, DC, DE, FL, GA, IL, IN, KY, MA, ME, MD, MI, MS, NC, NH, NJ, NY, OH, PA, RI, SC, TN, VA, VT, WI, or WV, return this form to:

New York Life, Cleveland Service Center

PO Box 6916, Cleveland, OH 44101

If You Live In: AK, AR, AZ, CA, CO, HI, IA, ID, KS, LA, MN, MO, MT, NE, ND, NM, NV, OK, OR, SD, TX, UT, WA, or WY, return this form to: New York Life, Dallas Service Center PO Box 130539, Dallas, TX 75313-0539

Other: (i.e. foreign address, etc) return form to either location above.

4313 (05/08) Page 1 of 2

New York Life Insurance Company New York Life Insurance and Annuity Corporation (A Delaware Corporation) 51 Madison Avenue, New York, New York 10010 NYLIFE Insurance Company of Arizona (Not licensed in every state) 4343 North Scottsdale Road, Suite 220, Scottsdale, AZ 85251

RELEASE OF ASSIGNMENT

The consideration for which Policy No. ___________________, issued by New York Life Insurance Company, New York Life Insurance and Annuity Corporation, or NYLIFE Insurance Company of Arizona on the life of

_____________________________________________________________________________(the Insured)

Insured's Name

of _______________________________________________________________________________, was assigned to

Insured's Address

____________________________________________________________________________________ has been fully

Assignee's Name

paid and satisfied. Therefore, I/we hereby relinquish all interest in this policy as Assignee.

______________

Date

X ________________________________________________________

Assignee's Signature (if Corporate Officer, include title)

________________ Date

X _______________________________________________________________ Additional Signature, if required (if Corporate Officer, include title)

NEW YORK LIFE INSURANCE COMPANY or NEW YORK LIFE INSURANCE AND ANNUITY CORPORATION or NYLIFE INSURANCE COMPANY OF ARIZONA has retained the duplicate copy of this assignment. The Company or Corporation assumes no responsibility for the validity of the assignment.

________________ Date

X _______________________________________________________________ Signature for the Company or Corporation

FOR OFFICE USE ONLY

Date Received Stamp Here

Returned To ___________________________________

By _____________________ Date _________________

4313 (05/08) Page 2 of 2

 ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download