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It specifies payment frequency options, first payment date rules, and Direct Deposit requirements, including a written request process to start, change, or stop withdrawals. The form also collects federal and state income tax withholding preferences, outlines backup-withholding and FATCA certification statements, and includes signature and date lines.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":41,"@type":70,"position":76},"https://docshare.wps.com/template/letters/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/oceanview-life-and-annuity-company-contract-and-distribution-election-income-tax-withholding-and-certification-form/302988/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/oceanview-life-and-annuity-company-contract-and-distribution-election-income-tax-withholding-and-certification-form/302988.png","ImageObject",442,249,{"name":88,"@type":89},"Asher","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-02","2026-09-19",true,{"@type":98,"interactionType":99,"userInteractionCount":47},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"How do I choose automatic withdrawal income options?","Question",{"text":108,"@type":109},"Select only one distribution option for receiving income via automatic withdrawals. The form also notes that withdrawals exceeding 10% during the surrender charge period may be subject to surrender charges.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"What payment frequencies are available and how is the first payment date handled?",{"text":113,"@type":109},"Choose a frequency: annually, semi-annually, quarterly, or monthly. The form requires selecting a first payment month/day, and subsequent payments are generated on the same day unless it falls on a non-business day.",{"name":115,"@type":106,"acceptedAnswer":116},"How do I set federal and state income tax withholding preferences?",{"text":117,"@type":109},"Mark one federal withholding option (including withholding 10%, withholding another amount, or choosing not to withhold). If federal tax is withheld, state withholding may be automatically applied for specified states, with an option to opt out where allowed.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},302988,1790316788,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":40,"category_name":41,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":47,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":73,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":139,"read_time":9},687197207639,"https://ap-avatar.wpscdn.com/davatar_a8503ba1806abce46bf441b54a3ca4cd","Oceanview Life and Annuity Company • PO Box 830 Grimes, IA 50111-0830 • Tel 888.295.3815 • [www.oceanviewlife.com](www.oceanviewlife.com)  \n\n| 1. CONTRACT INFORMATION |  |\n| --- | --- |\n| Contract Number |  |\n|  | Name of Annuitant |\n| Name of Contract Owner | Social Security Number |\n| Street Address, City, State, Zip\u003Cbr> Please check if this is a permanent address change. | Telephone Number |\n| Name of Joint Owner | Social Security Number |\n| 2. DISTRIBUTION ELECTION |  |\n| I wish to receive income via automatic withdrawals as indicated below (Please check only one option):  Interest earned during the frequency elected below\u003Cbr> Specified Dollar Amount of $ \u003Cbr> Specified Percentage of the contract value   %(The amount will be recalculated each contract anniversary and distributed equally among all payments.)\u003Cbr>Please note:\u003Cbr>If, during the surrender charge period, the total amount of withdrawals taken from this contract exceeds 10% of the contract value during the contract year, any withdrawals in excess of the 10% will be subject to surrender charges.\u003Cbr>Interest rates are expressed as annual effective interest rates. Any withdrawals taken during the contract year will reduce the actual earned interest amount. |  |\n| A written request must be received to start, change or stop withdrawals under this option. |  |\n\n3. PAYMENT FREQUENCY and DISTRIBUTION METHOD  \nThe payment must be at least $100.00. If distribution is requested by Direct Deposit, please fill out the Electronic Funds Deposit Authorization Form, otherwise a check will be issued for each payment.  \nFREQUENCY:  Annually  Semi-Annually  Quarterly  Monthly (Monthly payments are available only through direct  \ndeposit. Please complete and return the Electronic Funds Deposit Authorization with this form)  \nFIRST PAYMENT DATE:   Please select the Month/Day you would like payments to begin – other than the 29th,  \n30th or 31st.. (Subsequent payments will be generated on the same day, depending upon the frequency of payment, If this day is not a business day, the payment will be generated on the next business day.)  \nOceanview Life and Annuity Company • PO Box 830 Grimes, IA 50111-0830 • Tel 888.295.3815 • [www.oceanviewlife.com](www.oceanviewlife.com)  \n\n| 4. INCOME TAX WITHHOLDING FOR CONVERSION |\n| --- |\n| FEDERAL WITHHOLDING – Please Check One (If no election is made, federal income tax will be withheld.)\u003Cbr> Withhold 10%\u003Cbr> Withhold another amount: $   or   %\u003Cbr> Do not withhold federal income tax\u003Cbr>STATE WITHHOLDING If you reside in one of the following states – CA, DC, DE, GA, IA, KS, MA, ME, MI*, NE, NC OK, OR, VT, or VA – and federal income tax is withheld, we will automatically withhold state income tax. If your state allows, you may opt out. See the enclosed State Tax Withholding Information to determine if your state allows you to opt out. If you do not reside in one of the states previously listed, you may still elect to withhold UNLESS you live in AK, FL, NH, NV, SD, TN, TX, WA, WY. Please check one of the following boxes.\u003Cbr> Do not withhold. I live in one of the states listed above, but my state allows me to opt out\u003Cbr> Withhold $   or   %\u003Cbr>*MICHIGAN RESIDENTS – Please refer [to](to www.michigan.gov/taxes for)[ ](to www.michigan.gov/taxes for)[www.michigan.gov/taxes](to www.michigan.gov/taxes for)[ for](to www.michigan.gov/taxes for) information regarding the MI W-4P form for tax withholding, or opt out information. If the MI W-4P is not returned, we are required to withhold state income tax.\u003Cbr>Notice: Federal law requires withholding a minimum of 10% Federal Income Tax from taxable distributions, unless you elect not to have taxes withheld or specify a different withholding amount. Withholding will only apply to that portion of your distribution that is includable in your income subject to Federal Income Tax. You may revoke this withholding election at any time by contacting Oceanview Life and Annuity Company in writing. Electing not to withhold a","cbCaig63QLYyIZsk","https://ap.wps.com/l/cbCaig63QLYyIZsk","pdf",186041,"English","# Contract Information\n# Distribution Election\n# Payment Frequency and Distribution Method\n# Income Tax Withholding for Conversion\n# Certification of Taxpayer Identification\n# Signatures","[{\"question\":\"How do I choose automatic withdrawal income options?\",\"answer\":\"Select only one distribution option for receiving income via automatic withdrawals. The form also notes that withdrawals exceeding 10% during the surrender charge period may be subject to surrender charges.\"},{\"question\":\"What payment frequencies are available and how is the first payment date handled?\",\"answer\":\"Choose a frequency: annually, semi-annually, quarterly, or monthly. The form requires selecting a first payment month/day, and subsequent payments are generated on the same day unless it falls on a non-business day.\"},{\"question\":\"How do I set federal and state income tax withholding preferences?\",\"answer\":\"Mark one federal withholding option (including withholding 10%, withholding another amount, or choosing not to withhold). If federal tax is withheld, state withholding may be automatically applied for specified states, with an option to opt out where allowed.\"}]","Oceanview Life and Annuity Company - Contract and Distribution Election - Income Tax Withholding and Certification Form | PDF",1789799380]