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Contract Holder Forms

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Contract Holder Forms - Annuitization

Annuity Payout Benefit

ML2084

Direct Deposit Request (for active recurring distribution only)

ML2775

RMD Withdrawal for IRA (one-time and systematic)

ESP2941 IRA

Special Tax Notice (Non Roth)

ADM2306

Special Tax Notice (Roth)

N6060518NW

Contract Holder Forms - Loan

Loan Application

TSAL2798

Qualified Annuity Contract Loan Application and Agreement for Contracts Issued by National Health Insurance

TSALNHIC

Request for Automated Loan Payments

ML2713

Contract Holder Forms - Other

403(b) TSA - Rollover Contribution Plan Administrator Certification

S6038212NW

403(b)/457 Plan to Plan Transfer Request

X6028909NW

California Facility Care/Home Care/Community-Based Services Request

K6050315CA

Contract Purchase Acknowledgement and Affirmation

S2657713NW

Custodian Addendum to Client Financial Disclosure

D2656512NW

Notarized Signature for Electronic Applications

X6046114NW

Statement of Claim Long-Term Care Confinement & Terminal Illness Requests

MF12515

Contract Holder Forms - Policy Maintenance

Address Change/Beneficiary Change/Information Request

ASM2044

Beneficiary Change (Annuitized Contracts Only)

ASM2134

Beneficiary Designation and Restricted Death Benefit Election

X1053406NW

Collateral Assignment Form

ASM2328

Collateral Assignment Release Form

S6065420NW

Contract/Certificate Ownership/Annuitant Change

X6002701NW

RMD Withdrawal (one-time and systematic)

ESP2941 U

RMD Withdrawal for IRA (one-time and systematic)

ESP2941 IRA

Servicing Agent/ Producer Request Form

X6064920NW

Systematic Substantially Equal Periodic Payment Election Continuation from Prior Carrier

X6051815NW

Systematic Withdrawal (For 403/401/457 Tax Qualifications)

ESP2942

Systematic Withdrawal (For NQ and IRA Tax Quals Only)

ESP2942 NQ IRA

Systematic Withdrawal for Substantially Equal Periodic Payments

X6051715NW

TSA Premature Waiver Distribution

ML2319

Withdrawal/Surrender Request

AB2151

Contract Holder Forms - Rider

Income Rider Activation

X6026409NW

Contract Holder Forms - Tax

Tax Qualification Change – IRAs

S2652512NW

Tax Qualification Change/Plan Distribution – 403b/401k/457 Plans

S2656612NW

Contract Holder Forms - Withdrawal

RMD Withdrawal (one-time and systematic)

ESP2941 U

RMD Withdrawal for IRA (one-time and systematic)

ESP2941 IRA

Special Tax Notice (Non Roth)

ADM2306

Special Tax Notice (Roth)

N6060518NW

Systematic Withdrawal (For 403/401/457 Tax Qualifications)

ESP2942

Systematic Withdrawal (For NQ and IRA Tax Quals Only)

ESP2942 NQ IRA

Systematic Withdrawal for Substantially Equal Periodic Payments

X6051715NW

Withdrawal/Surrender Request

AB2151

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© 2025 MassMutual Ascend Life Insurance Company. All rights reserved. Products issued by MassMutual Ascend Life Insurance Company, a wholly owned subsidiary of Massachusetts Mutual Life Insurance Company (MassMutual).

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