Article Guide
The New York 8104 form is a crucial document for policyholders of New York Life Insurance and its affiliated companies. It facilitates various transactions related to life insurance policies, specifically concerning dividend options and tax withholding. The form allows policyholders to change their dividend options, which can impact how dividends are applied—whether they are used for paid-up additions, left to accumulate interest, or applied towards premiums. Additionally, the form includes an important section for income tax withholding, where policyholders must indicate their preferences regarding federal and state tax deductions on any taxable gains. This section is vital, as it ensures compliance with IRS requirements and helps avoid unexpected tax liabilities. By providing clear instructions and options, the 8104 form empowers policyholders to make informed decisions about their insurance dividends and tax implications, ultimately enhancing their financial management strategies.
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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 |
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Insured Information
Policy Number |
Name |
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Policy Owner information |
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Name (if different than above) |
Social Security */ TAX ID (Required) |
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Daytime Phone # |
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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
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
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
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
*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 |
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(This option may not be available for residents |
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of certain states. See the State Income Tax |
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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.
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Policy Owner Signature |
Name (Printed) |
Date |
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Policy Owner Signature |
Name (Printed) |
Date |
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RETURN FORM TO: |
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New York Life |
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P.O. Box 130539 |
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Dallas, TX |
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8104 (6/2016) Page 2 of 3
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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
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.
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
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
Form Specifications
| Fact Name | Details |
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| Form Purpose | The New York 8104 form is used to change dividend options for life insurance policies. |
| Governing Law | This form is governed by New York State Insurance Law. |
| Effective Date | Changes to dividend options become effective on the policy anniversary if submitted 31 days prior. |
| Dividend Options | Policyholders can choose between options like Paid-Up Additions or cash payments. |
| Tax Withholding Requirement | The IRS mandates completion of the tax withholding section to avoid automatic withholding of 10% on taxable gains. |
| Signature Requirement | The policy owner must sign the form to certify their taxpayer identification information. |
| Return Address | Completed forms should be sent to New York Life at P.O. Box 130539, Dallas, TX 75313-0539. |
New York 8104: Usage Guidelines
Completing the New York 8104 form is straightforward. This form requires specific information about your life insurance policy and your preferences regarding dividend options and tax withholding. Follow the steps below to ensure you fill it out correctly.
- Start by entering your policy number at the top of the form.
- Provide your name as the insured individual.
- If the policy owner is different from the insured, fill in the policy owner's name.
- Include the policy owner's Social Security number or Tax ID, which is required.
- Enter a daytime phone number and an email address for communication.
- Decide on your dividend option change. For policies with a One Year Term option, select one of the options provided in Section A.
- If your policy does not have a One Year Term option, choose an option from Section B.
- Move to the Income Tax Withholding Section. Indicate whether you are a U.S. citizen or resident alien by checking "Yes" or "No."
- Select your preferred tax withholding option by checking the appropriate box. You may choose to have no taxes withheld, only federal taxes withheld, or both federal and state taxes withheld.
- If applicable, specify the percentage for federal and state withholding in the spaces provided.
- Sign the form where indicated to certify your information is correct. Include the printed name and date of signing.
- Finally, return the completed form to New York Life at the address provided on the form.
Your Questions, Answered
What is the purpose of the New York 8104 form?
The New York 8104 form is used to change the dividend option on a life insurance policy issued by New York Life. Policyholders can select how they want their dividends to be applied, including options such as paid-up additions, cash payments, or leaving dividends on deposit to accumulate interest. This form also addresses tax withholding options for any withdrawals made from the policy.
Who needs to complete the New York 8104 form?
The form must be completed by the policy owner, who is typically the individual who holds the insurance policy. If the policy owner is different from the insured, the form must include both names and relevant information. Accurate completion is essential to ensure that the requested changes are processed correctly.
What are the dividend options available on the New York 8104 form?
Policyholders can choose from several dividend options. These include providing paid-up additions, leaving dividends to accumulate interest, applying dividends to premium payments, or receiving dividends in cash. Specific options may vary depending on whether the policy has a one-year term rider or not. It's important to note that certain conditions apply to these options, particularly for policies issued during specific time frames.
What is the deadline for submitting the New York 8104 form?
The request for a dividend option change must be received by New York Life at least 31 days before the current policy anniversary date for it to take effect on that date. If the form is submitted after this deadline, the changes will be applied to the next policy anniversary instead.
What tax implications should policyholders be aware of when using the New York 8104 form?
Policyholders must consider the tax implications of withdrawing dividends. The IRS requires that a flat 10% be withheld from the taxable portion of any withdrawal unless the policyholder opts out of withholding. Additionally, state income tax withholding may apply depending on the policyholder's residence. Consulting a tax advisor is recommended to understand the specific implications and options available.
How should the completed New York 8104 form be submitted?
The completed form should be mailed to New York Life at the address provided on the form: P.O. Box 130539, Dallas, TX 75313-0539. It is important to ensure that all required fields are filled out accurately to avoid delays in processing the request.
Common mistakes
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Neglecting to Provide Accurate Personal Information: Many individuals fail to double-check their name, Social Security number, or Tax ID. Mistakes here can lead to significant delays or issues with processing the form.
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Missing the Deadline for Dividend Option Changes: It’s crucial to submit any changes at least 31 days before the policy anniversary. Failing to do so means the changes won’t take effect until the next anniversary.
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Overlooking Tax Withholding Requirements: Some people forget to complete the tax withholding section. This can result in automatic withholding of 10% from taxable gains, which may not align with their financial plans.
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Choosing the Wrong Dividend Option: Selecting an incorrect dividend option can have lasting effects on policy benefits. It’s essential to understand each option before making a choice.
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Failing to Sign the Form: A signature is required for the form to be valid. Forgetting this crucial step can delay processing and cause unnecessary complications.
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Ignoring State-Specific Requirements: Different states have unique rules regarding tax withholding. Not being aware of these can lead to unexpected tax liabilities.
Documents used along the form
The New York 8104 form is an important document for policyholders of New York Life Insurance. It primarily deals with dividend options and tax withholding elections related to life insurance policies. However, there are several other forms and documents that often accompany the 8104 form to ensure that all necessary information is collected and processed correctly. Below are some commonly used forms that may be relevant.
- Form W-9: This form is used to provide your correct taxpayer identification number (TIN) to the insurance company. It is essential for tax reporting purposes, especially when receiving dividends or withdrawals from your policy.
- Form W-4P: This form is specifically for withholding on pension or annuity payments. If you choose to have federal income tax withheld from your policy distributions, this form helps you indicate your withholding preferences.
- Form 1099: This is a tax form that reports the taxable income you received from your insurance policy. If you withdraw dividends or receive any taxable gains, the insurance company will issue a 1099 form to you and the IRS, detailing the amount received.
- State Tax Withholding Form: Some states require a specific form to be filled out for state income tax withholding. This form allows you to elect whether or not to have state taxes withheld from your policy distributions, depending on your state’s regulations.
Understanding these additional forms can help you manage your life insurance policy more effectively. Each document plays a crucial role in ensuring compliance with tax regulations and making informed decisions about your policy's dividends. Always consult with a tax advisor or financial professional if you have questions about how these forms apply to your situation.
Similar forms
- Form W-4: Similar to the New York 8104 form, Form W-4 is used by employees to indicate their tax withholding preferences. Both forms require individuals to specify how much tax should be withheld from payments, ensuring compliance with tax obligations.
- Form W-9: Like the 8104, Form W-9 is used to provide taxpayer identification information. Both forms collect crucial details such as Social Security numbers or Tax IDs, which are essential for tax reporting purposes.
- Form 1099: This form is issued for reporting various types of income, including dividends. Similar to the 8104, it is concerned with tax implications and requires accurate reporting to the IRS.
- Form 1040: The primary individual income tax return form, Form 1040, is similar in that it requires individuals to report income, including taxable gains from policies. Both forms play a role in the overall tax reporting process.
- State Tax Withholding Forms: Many states have their own forms for tax withholding, similar to the 8104. These forms ensure that state income taxes are appropriately withheld from payments, reflecting state-specific requirements.
- Form 1098: This form is used to report mortgage interest, but it also involves tax implications. Like the 8104, it requires accurate reporting of financial information that affects tax liabilities.
- Form 4506-T: This form is used to request a transcript of tax returns. Similar to the 8104, it is part of the tax documentation process, ensuring that individuals can access their tax records when needed.
- Form 8889: This form is for Health Savings Accounts (HSAs) and is similar in that it requires individuals to report specific financial transactions that have tax implications, much like the dividend options on the 8104.
Dos and Don'ts
- Do double-check your personal information.
- Don't leave any required fields blank.
- Do ensure that your social security number or Tax ID is accurate.
- Don't forget to review the dividend options carefully before making a selection.
- Do consult with a tax advisor if you have questions about tax withholding.
Filling out the New York 8104 form is an important step in managing your insurance policy effectively. Pay attention to the details, as they can significantly impact your policy's benefits and tax implications. Each decision you make on this form should be informed and deliberate.
Misconceptions
Misconceptions about the New York 8104 form can lead to confusion for policyholders. Here are six common misunderstandings:
- It is only for tax purposes. Many believe that the 8104 form is solely for tax withholding. In reality, it also includes options for changing dividend options and managing policy loans.
- All policies require the form. Some think every insurance policy necessitates the 8104 form. However, it is primarily used for policies with dividend options, not all policies.
- Tax withholding is automatic. There is a misconception that taxes will automatically be withheld from any withdrawals. While withholding is required in some cases, policyholders can choose whether or not to have taxes withheld.
- Changes take effect immediately. Some individuals assume that any changes made on the form will be effective right away. In fact, changes typically take effect on the next policy anniversary if the request is submitted on time.
- Only one option can be selected. Many believe they can only choose one option for dividends. In truth, policyholders can select different options for different scenarios, such as for policies with and without a one-year term rider.
- Filing the form is optional. Some think that submitting the 8104 form is optional for all policyholders. However, if a policyholder wishes to change dividend options or manage tax withholding, completing the form is necessary.
Understanding these misconceptions can help policyholders make informed decisions regarding their insurance policies.
Key takeaways
When filling out the New York 8104 form, there are several important points to keep in mind to ensure a smooth process. Here are key takeaways:
- Policy Information: Clearly provide the policy number and the name of the insured. If the policy owner differs from the insured, include their name and Social Security or Tax ID number.
- Dividend Options: Be aware of the dividend options available. Changes to these options take effect on the policy anniversary date if submitted at least 31 days prior.
- One Year Term Option: If your policy includes a one-year term rider, you must select how to handle dividends, whether to cancel the rider or retain it with a new dividend option.
- Tax Withholding Section: Complete this section carefully. The IRS mandates that you specify your withholding preferences to avoid default withholding.
- Signature Requirement: The policy owner’s signature is mandatory. Ensure all required certifications are accurate to avoid complications.
- Consultation Recommended: It’s wise to consult with a tax advisor regarding tax implications, especially if you are unsure about withholding options.
- State-Specific Rules: Different states have unique withholding requirements. Check your state’s regulations to ensure compliance.
By keeping these takeaways in mind, you can navigate the New York 8104 form more effectively and avoid potential pitfalls.