Homepage Free New York 8104 Form
Jump Links

The New York 8104 form is an important document used by policyholders of New York Life Insurance Company and its affiliates to manage dividend options and tax withholding related to their life insurance policies. This form requires the insured to provide personal information, including the policy number, name, and contact details. Policyholders can choose how to handle dividends, which can be applied in various ways such as providing paid-up additions, accumulating interest, or paying premiums and loan interest. It is essential to note that any changes to the dividend option will take effect on the current policy anniversary date if the request is submitted at least 31 days prior. The form also includes a section for income tax withholding elections, where policyholders must indicate their preferences for federal and state tax withholdings on any taxable gains from dividend withdrawals. This section is crucial, as failure to provide a Social Security number or Tax ID may result in mandatory withholding of taxes. Additionally, the form requires the policy owner's signature to certify the accuracy of the provided information and compliance with tax obligations. Understanding the implications of each choice on the form is vital for policyholders to make informed decisions regarding their insurance benefits and tax responsibilities.

Similar forms

The New York 8104 form is designed to facilitate various aspects of life insurance policy management, particularly regarding dividend options and tax withholding. There are several other documents that serve similar purposes, each addressing specific needs within the insurance or financial landscape. Here’s a look at six documents that share similarities with the New York 8104 form:

  • Form W-4: This form is used by employees to indicate their tax situation to their employer. Like the 8104, it allows individuals to specify withholding preferences, impacting their income tax deductions.
  • Form W-9: This form is utilized to provide taxpayer identification information to entities that will report payments made to individuals. Similar to the 8104, it ensures compliance with tax regulations and helps prevent backup withholding.
  • Form 1099: Issued by financial institutions, this form reports various types of income other than wages. Both the 1099 and the 8104 involve tax implications, as they help track taxable events related to financial products.
  • Form 4506-T: This form allows individuals to request a transcript of their tax return. It serves a similar purpose in verifying income and tax status, akin to how the 8104 manages tax withholding for insurance dividends.
  • Policy Change Request Form: This document allows policyholders to request changes to their insurance policies, such as beneficiary updates or coverage modifications. Like the 8104, it facilitates communication between the policyholder and the insurance company regarding important policy details.
  • Withdrawal Request Form: Used to request withdrawals from an insurance policy or retirement account, this form shares similarities with the 8104 in that it outlines the specifics of the withdrawal and any tax implications associated with it.

Each of these documents plays a critical role in managing financial and tax-related decisions, ensuring that individuals maintain compliance while also addressing their specific needs.

Form Preview

Next >

Print...

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

< Back

Next >

Print...

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

 

 

 

8104 (6/2016) Page 2 of 3

< Back

 

Print...

 

 

 

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

Common mistakes

Filling out the New York 8104 form can be straightforward, but there are common mistakes that individuals often make. One frequent error is failing to provide the correct Social Security number or Tax ID. This information is mandatory and must be accurate to avoid delays or issues with processing the form.

Another common mistake is neglecting to check the appropriate boxes regarding dividend options. Individuals may overlook the importance of selecting either the one-year term rider or the options for policies without it. This can lead to unintended consequences regarding how dividends are applied.

Many people also forget to consider the timing of their requests. The form specifies that requests for dividend option changes must be received at least 31 days before the current policy anniversary date. Missing this deadline can result in the change taking effect later than intended.

In the tax withholding section, individuals often misinterpret the requirements. Some may fail to indicate their preferences for federal and state tax withholding percentages, leading to automatic defaults that may not align with their financial plans. It is essential to specify these percentages to avoid unexpected tax implications.

Another mistake involves not signing the form. The policy owner's signature is a required element, and without it, the form will not be processed. Individuals should ensure they have signed and dated the form before submission.

Additionally, individuals sometimes misunderstand the implications of electing out of tax withholding. While it may seem beneficial to avoid withholding, this decision can lead to larger tax liabilities later. Consulting with a tax advisor can provide clarity on this matter.

Finally, people may overlook the importance of reviewing the entire form before submission. Errors or omissions can lead to processing delays or complications. Taking a moment to double-check all entries can save time and prevent issues down the line.

More About New York 8104

  1. What is the New York 8104 form?

    The New York 8104 form is a document used by policyholders of New York Life Insurance to make changes to their dividend options, request tax withholding, and provide necessary personal information. It is essential for managing your life insurance policy effectively.

  2. Who can use the New York 8104 form?

    This form is intended for policyholders of New York Life Insurance Company, NYLIFE Insurance Company of Arizona, and New York Life and Annuity Corporation. If you own a policy with any of these companies, you can use this form to manage your policy's dividend options and tax withholding.

  3. What are dividend options?

    Dividend options are choices available to policyholders regarding how dividends earned on their life insurance policy are utilized. You can choose to receive dividends in cash, apply them to premiums, or purchase paid-up additions, among other options. Selecting the right option can impact the growth and benefits of your policy.

  4. How do I change my dividend option?

    To change your dividend option, fill out the appropriate section of the New York 8104 form. Ensure that you submit your request at least 31 days before your policy's anniversary date for it to take effect on the current anniversary. If submitted later, the change will take effect on the next anniversary.

  5. What happens if I miss the 31-day deadline?

    If you miss the 31-day deadline, your dividend option change will not take effect until the following policy anniversary. It’s important to plan ahead and submit your requests in a timely manner to avoid delays.

  6. What is the tax withholding section for?

    The tax withholding section allows you to elect how much federal and state income tax, if any, you want withheld from your policy dividends or withdrawals. This is crucial for ensuring you meet your tax obligations and avoid unexpected tax bills.

  7. Can I opt out of tax withholding?

    Yes, you can choose to opt out of tax withholding by selecting the appropriate option on the form. However, if you do not provide your Social Security number or taxpayer identification number, federal law requires a 10% withholding on taxable gains.

  8. What if I am not a U.S. citizen?

    If you are not a U.S. citizen or resident alien, you need to submit Form W-8 along with the New York 8104 form to certify your foreign status and claim any applicable treaty benefits. This is important to ensure compliance with tax regulations.

  9. What should I do if I have questions about the form?

    If you have questions about the New York 8104 form, it’s a good idea to consult with a tax advisor or contact New York Life’s customer service for assistance. They can provide guidance specific to your situation and help clarify any uncertainties.

  10. Where do I send the completed form?

    Once you’ve completed the New York 8104 form, send it to New York Life at the address provided on the form: P.O. Box 130539, Dallas, TX 75313-0539. Ensure you keep a copy for your records.

Misconceptions

Misconception 1: The 8104 form is only for tax purposes.

While the form does involve tax withholding options, it primarily serves to manage dividend options for life insurance policies. It's essential to understand that it addresses how dividends are handled, not just taxes.

Misconception 2: You can change your dividend option anytime without restrictions.

Changes to your dividend option only take effect if submitted at least 31 days before your policy's anniversary date. If you miss this window, your change will apply to the next anniversary.

Misconception 3: All policies have the same dividend options.

This is not true. Policies with a One Year Term Option have different choices compared to those without. Make sure to review your specific policy details before selecting an option.

Misconception 4: Federal tax withholding is optional for everyone.

For some policyholders, especially non-persons or U.S. citizens living abroad, opting out of federal tax withholding is not allowed. It’s crucial to understand your specific situation and requirements.

Key takeaways

When filling out and using the New York 8104 form, keep the following key takeaways in mind:

  • Insured Information: Always include the policy number and the name of the insured accurately.
  • Policy Owner Details: If the policy owner is different from the insured, provide their name and Social Security or Tax ID number.
  • Dividend Option Changes: Changes to the dividend option will take effect on the current policy anniversary if submitted at least 31 days in advance.
  • One Year Term Option: Choose whether to cancel the One Year Term Rider or retain it while changing dividend options.
  • Whole Life Additions: Be aware that Whole Life Additions are only available for policies issued between April 7, 1975, and February 1, 1988.
  • Tax Withholding Section: Completing this section is essential to comply with IRS requirements regarding tax withholding on withdrawals.
  • Federal Tax Withholding: If no withholding election is made, a flat 10% will automatically be withheld from the taxable portion of your payment.
  • State Tax Considerations: Some states require additional withholding if federal income tax is withheld. Check your state’s specific requirements.
  • Signature Requirement: The policy owner's signature is mandatory. Ensure that all certifications regarding tax information are accurate.
  • Consult a Tax Advisor: It’s wise to seek advice from a tax professional if you have questions about your tax withholding options.

New York 8104: Usage Guide

Completing the New York 8104 form is a straightforward process. Follow these steps carefully to ensure all necessary information is provided accurately. This will help facilitate your request efficiently.

  1. Gather your personal information, including your name, Social Security number or Tax ID, and daytime phone number.
  2. Locate your policy number and the name of the policy owner. If the owner is different from the insured, provide that name as well.
  3. Choose your dividend option change. If your policy has a One Year Term option, select the appropriate box in Section A. If it doesn’t, select from Section B.
  4. Complete the Income Tax Withholding section. Indicate whether you are a U.S. citizen and select your withholding preferences.
  5. If you choose to have taxes withheld, specify the percentage for federal and state withholding, if applicable.
  6. Sign and date the form. Ensure your signature matches the name printed above.
  7. Return the completed form to New York Life at the address provided on the form.