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The New York 8104 form is an important document for policyholders of New York Life Insurance Company and its affiliates. It primarily deals with dividend options and tax withholding elections related to life insurance policies. Policyholders can request changes to how their dividends are applied, such as opting for paid-up additions or cash payments. Additionally, the form requires policyholders to provide personal information, including their Social Security number or Tax ID, to ensure accurate processing. A significant aspect of the 8104 form is its section on income tax withholding, which mandates that policyholders make informed choices regarding federal and state tax deductions on their dividends. Understanding these options is crucial, as incorrect selections can lead to unexpected tax liabilities. The form also emphasizes the importance of timely submissions, particularly for dividend option changes, which take effect on the policy anniversary date if submitted within the required timeframe. Overall, the New York 8104 form serves as a vital tool for managing life insurance dividends and ensuring compliance with tax regulations.

New York 8104 Example

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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

 

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

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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

 

(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

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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 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

File Breakdown

Fact Name Details
Form Purpose The New York 8104 form is used to request changes to the dividend options on life insurance policies issued by New York Life Insurance Company and its affiliates.
Dividend Option Change Changes to the dividend option become effective on the current policy anniversary date if submitted at least 31 days prior to that date. Otherwise, changes take effect on the next anniversary.
Tax Withholding Requirements The IRS mandates that if a Social Security number or Tax ID is not provided, 10% of the taxable gain will be withheld. Tax withholding options must be specified to avoid default withholding.
State-Specific Regulations Certain states, including Iowa, Kansas, and Virginia, require state income tax withholding when federal tax withholding is applied. Consult your state tax authority for specific requirements.
Signature Requirement The policy owner's signature is required on the form to certify the accuracy of the provided information and to authorize any changes requested.

Guide to Using New York 8104

Filling out the New York 8104 form requires careful attention to detail. Once you complete the form, it should be submitted to New York Life for processing. Ensure that all information is accurate to avoid delays in processing your request.

  1. Begin by entering your policy number and your name as the insured.
  2. If the policy owner differs from the insured, provide the policy owner's name, Social Security number or Tax ID, daytime phone number, and email address.
  3. Choose your dividend option by selecting the appropriate box under either Policies With One Year Term Option or Policies Without One Year Term Option.
  4. If applicable, fill out the Income Tax Withholding Section. Indicate whether you are a U.S. citizen or resident alien and select your withholding preferences.
  5. Specify the percentage of taxable portion you wish to apply to federal and/or state withholding, if applicable.
  6. Sign the form where indicated to certify your information is correct and that you meet the necessary requirements.
  7. Print your name and the date next to your signature.
  8. Mail the completed form to the address provided: New York Life, P.O. Box 130539, Dallas, TX 75313-0539.

Get Answers on New York 8104

What is the New York 8104 form?

The New York 8104 form is a document used by policyholders of New York Life Insurance Company to make changes related to their life insurance policies. This includes options for dividend distributions, tax withholding elections, and other important policy management decisions. It is essential for policyholders to complete this form accurately to ensure their requests are processed correctly.

Who needs to fill out the New York 8104 form?

Any policyholder of New York Life Insurance Company who wishes to change their dividend options, update tax withholding preferences, or provide necessary personal information must complete the 8104 form. If the policyholder’s information has changed or if they want to make specific elections regarding their policy, this form is required.

What are the dividend options available on the New York 8104 form?

Policyholders can choose from several dividend options on the 8104 form, including:

  1. Provide Paid-Up Additions
  2. Leave dividends on deposit to accumulate at interest
  3. Apply dividends to pay premiums or loan interest
  4. Pay dividends in cash
  5. Provide Whole Life Additions (specific policies only)

It’s important to note that certain options may only be available depending on the type of policy held.

When do changes made on the New York 8104 form take effect?

Changes to dividend options will take effect on the current policy anniversary date, provided the form is received by New York Life at least 31 days before that date. If the request is submitted after this period, the changes will be applied at the next policy anniversary.

What should I do if I want to change my tax withholding preferences?

The New York 8104 form includes a section for tax withholding elections. Policyholders can select whether they want federal and/or state income taxes withheld from their payments. It is crucial to consider the implications of these elections, as failing to withhold adequate taxes can lead to penalties. Consulting a tax advisor is advisable for personalized guidance.

What happens if I do not provide my Social Security Number or Tax ID?

If a policyholder does not provide their Social Security Number or Tax ID on the 8104 form, federal law mandates that 10% of the taxable gain will be withheld from their payment. This withholding occurs automatically to comply with IRS regulations.

Can I change my withholding election after submitting the form?

Yes, policyholders can change their withholding election at any time. The election made on the 8104 form will apply to all future payments from the same policy unless a new election is submitted. It is important to keep records of any changes made for future reference.

What are the penalties for early withdrawal from my policy?

Withdrawing from a life insurance policy before the age of 59½ may incur a 10% IRS penalty on the taxable portion of the withdrawal. Exceptions exist, such as cases of disability. Policyholders should be aware of these penalties and consider them before making a withdrawal decision.

Where should I send the completed New York 8104 form?

Once completed, the New York 8104 form should be sent to New York Life at the following address:

New York Life
P.O. Box 130539
Dallas, TX 75313-0539

Ensuring that the form is sent to the correct address is crucial for timely processing.

Common mistakes

Filling out the New York 8104 form can be straightforward, but many people make common mistakes that can delay processing or lead to incorrect information being recorded. One significant error is failing to provide a correct Social Security number or Tax ID. This information is mandatory, and without it, the form cannot be processed, leading to potential tax withholding issues.

Another frequent mistake involves not checking the appropriate boxes in the dividend option section. If you select a dividend option that does not align with your policy type, it can result in unintended consequences, such as incorrect dividend distributions. Always ensure that the selected option corresponds to the terms of your policy.

People often neglect to review the deadline for submitting changes to dividend options. The form states that requests must be received at least 31 days before the current policy anniversary date. If this timeline is not adhered to, changes will take effect only on the next anniversary, which can be frustrating for policyholders.

Inaccurate completion of the income tax withholding section is another common issue. Individuals sometimes fail to indicate their withholding preferences clearly. If no percentage is specified, the default withholding of 10% may be applied, which might not be what the individual intended.

Another mistake occurs when policy owners forget to sign the form. The signature is required to certify the accuracy of the information provided. Without a signature, the form is incomplete and cannot be processed.

Some individuals overlook the importance of consulting with a tax advisor before making withholding elections. The implications of these decisions can be significant, and understanding the tax consequences is crucial for compliance and financial planning.

Failing to indicate whether one is a U.S. citizen or resident alien can lead to complications. This status affects tax withholding and reporting obligations. It is essential to provide this information accurately to avoid issues with the IRS.

Many people also neglect to keep a copy of the completed form for their records. This can create problems later if there are questions about the submitted information or if discrepancies arise.

Lastly, individuals sometimes submit the form to the wrong address. Ensuring that the form is sent to the correct location is vital for timely processing. Double-check the return address before mailing the form to avoid delays.

Documents used along the form

The New York 8104 form is an important document related to life insurance policies, particularly for managing dividend options and tax withholding. When completing this form, several other documents may also be required or helpful in the process. Below is a list of forms and documents that are commonly used alongside the New York 8104 form.

  • Form W-9: This form is used to provide your taxpayer identification number (TIN) to the insurance company. It ensures proper reporting of taxable income to the IRS.
  • Form W-4P: This form is specifically for withholding on pension or annuity payments. It allows policyholders to specify how much tax should be withheld from their payments.
  • Form 1099: This IRS form reports income received, including taxable gains from life insurance dividends. The insurance company issues it at the end of the tax year.
  • Dividend Option Rider: This document outlines the specific options available for handling dividends from your policy. It details how dividends can be applied, such as to premiums or as cash payments.
  • Policy Loan Agreement: If you have taken a loan against your policy, this agreement details the terms and conditions of the loan, including interest rates and repayment schedules.
  • State Tax Withholding Form: Some states require specific forms for tax withholding. This document ensures compliance with state laws regarding income tax on policy gains.
  • Beneficiary Designation Form: This form allows you to specify who will receive the benefits from your policy. It is important for ensuring that your wishes are followed.
  • Change of Beneficiary Form: If you wish to update your beneficiary designation, this form is necessary. It ensures that the insurance company has the most current information.

Having these documents ready can simplify the process when working with the New York 8104 form. It’s always a good idea to consult with a tax advisor or insurance professional if you have questions about your specific situation.

Similar forms

  • Form W-4: This form is used for employee withholding allowances for federal income tax. Like the New York 8104 form, it allows individuals to specify how much tax should be withheld from their income. Both forms require personal identification information and provide options for withholding amounts.
  • Form W-9: This form is utilized for providing taxpayer identification information to entities that will pay you. Similar to the New York 8104, it ensures that the correct tax information is reported to the IRS, requiring a signature to certify the information provided.
  • Form 1099: Issued for reporting various types of income other than wages, salaries, and tips. Like the New York 8104, it is essential for tax reporting purposes, as it informs the IRS about income received, including any taxable gains.
  • Form 1040: This is the standard individual income tax return form. It is similar in that it summarizes all income and tax information, including details that may stem from transactions reported on the New York 8104 form.
  • Form 1040-SR: Designed for seniors, this form is similar to the standard Form 1040 but tailored for individuals aged 65 and older. Both forms serve the purpose of reporting income and tax information, including that which may arise from insurance policy transactions.
  • Form 8889: This form is for Health Savings Accounts (HSAs) and allows individuals to report contributions and distributions. Like the New York 8104, it includes sections for tax withholding and requires personal information to ensure accurate reporting.
  • Form 5329: Used for reporting additional taxes on qualified plans, including IRAs. This form is similar to the New York 8104 in that it deals with tax implications related to distributions and requires detailed taxpayer information.
  • Form 8862: This form is for claiming the Earned Income Credit after disallowance. It shares similarities with the New York 8104 in that it requires personal identification and is used to ensure compliance with tax regulations.

Dos and Don'ts

When filling out the New York 8104 form, it is important to follow specific guidelines to ensure accuracy and compliance. Below is a list of dos and don'ts to consider.

  • Do provide your correct Social Security number or Tax ID. This information is required.
  • Do check the appropriate boxes for your dividend option changes. Make sure to select one option from each section.
  • Do read the tax withholding section carefully. Understanding your options can prevent unexpected tax liabilities.
  • Do sign and date the form. Your signature is required to validate the information provided.
  • Don't leave any sections blank. Incomplete forms may lead to processing delays.
  • Don't forget to consult with a tax advisor if you have questions about withholding options. This can help avoid penalties.
  • Don't submit the form without reviewing it for errors. Double-check all entries for accuracy.
  • Don't ignore the deadlines for submitting dividend option changes. Ensure your request is sent at least 31 days before the policy anniversary date.

Misconceptions

Understanding the New York 8104 form can be challenging, and several misconceptions can lead to confusion. Here are seven common misunderstandings about this form:

  • It is only for New York residents. Many believe that only residents of New York need to fill out this form. However, individuals from other states may also use it if they have policies issued by New York Life.
  • Filing the form is optional. Some people think that submitting the 8104 form is optional. In reality, if you wish to change your dividend options or withholdings, completing this form is necessary.
  • All dividend options are available for every policy. Not all policies allow for every dividend option. Certain options may only apply to specific types of policies or those issued within particular dates.
  • Tax withholding is automatic. Many assume that tax withholding will automatically occur. In fact, you must explicitly select your withholding preferences on the form.
  • Changes take effect immediately. Some individuals believe that any changes made on the form will take effect right away. Changes typically become effective on the next policy anniversary if submitted on time.
  • There are no penalties for early withdrawals. It is a common misconception that withdrawing dividends incurs no penalties. Withdrawals made before age 59½ may result in a 10% IRS penalty unless certain exceptions apply.
  • Only the policy owner can complete the form. While the policy owner usually fills out the form, authorized representatives may also complete it if they have the proper documentation.

By addressing these misconceptions, individuals can navigate the New York 8104 form more confidently and ensure they make informed decisions regarding their policies.

Key takeaways

Here are key takeaways for filling out and using the New York 8104 form:

  • Insured Information: Provide accurate details such as the policy number, name, and policy owner information. Ensure the Social Security number or Tax ID is included.
  • Dividend Option Change: Submit requests at least 31 days before the policy anniversary date for immediate effect. Late requests will take effect on the next anniversary.
  • Tax Withholding: Complete the tax withholding section carefully. If no SSN or TIN is provided, 10% will be withheld by default.
  • Signature Requirement: The policy owner must sign the form. This confirms the accuracy of the information provided and compliance with IRS regulations.
  • Consult a Tax Advisor: It's advisable to discuss tax implications with a tax professional, especially regarding withholding options and potential penalties.
  • State-Specific Rules: Be aware that some states have additional withholding requirements. Check state regulations to ensure compliance.