VA Form 29-1546-1 Application for Policy Loan/Cash Surrender

OMB Approved No. 2900-0012
Respondent Burden: 10 minutes

APPLICATION FOR POLICY LOAN
GOVERNMENT LIFE INSURANCE
PRIVACY ACT INFORMATION - We need this information to determine, establish, or verify your eligibility for VA Insurance benefits (38 U.S.C. 5902). Title 38,
United States Code, allows us to ask for this information. We estimate that you will need an average of 10 minutes to review the instructions, find the information,
and complete this form. VA cannot conduct or sponsor a collection of information unless a valid OMB control number is displayed. You are not required to respond
to a collection of information if this number is not displayed. Valid OMB control numbers can be located on the OMB Internet page at
www.whitehouse.gov/omb/library/OMBINV.VA.EPA.html#VA. If desired, you can call 1-800-827-1000 to get information on where to send comments or
suggestions about this form.
RESPONDENT BURDEN - The VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of
1974, or Title 5, Code of Federal Regulations 1.576 for routine uses identified in the VA system of records, 36VA00, Veterans and Armed Forces Personnel U.S.
Government Life Insurance Records - VA, published in the Federal Register. Your obligation to respond is voluntary, but your failure to provide us the information
could impede processing. Giving us your SSN account information is voluntary. Refusal to provide your SSN by itself will not result in the denial of benefits. The
VA will not deny an individual benefits for refusing to provide his or her SSN unless the disclosure of the SSN is required by Federal Statute of law in effect prior to
January 1, 1975, and still in effect. The responses you submit are considered confidential (38 U.S.C. 5701).

1. FIRST - MIDDLE - LAST NAME (Type or print)

2. INSURANCE FILE NUMBER

F
3. PERMANENT MAILING ADDRESS (Must be complete)

4. SOCIAL SECURITY NUMBER

5. DAYTIME TELEPHONE NUMBER

6. POLICY NUMBER(S) ON WHICH LOAN IS REQUESTED (Include letter prefix)

7. AMOUNT OF LOAN DESIRED (Check one)
$

(AMOUNT)

OR

MAXIMUM LOAN

8. DO YOU WISH TO USE DIVIDENDS TO REDUCE THE LOAN?
APPLY FUTURE DIVIDENDS TO PAY AN ANNUAL PREMIUM WITH THE
REMAINING BALANCE APPLIED TO REDUCE THE LOAN

APPLY EXISTING DIVIDEND CREDIT/DEPOSIT TO REDUCE LOAN
PRINCIPAL

APPLY FUTURE DIVIDENDS TO REDUCE LOAN PRINCIPAL
NOTE: Your VA compensation or pension or military retirement pay may be used to repay your loan. For more information, call the toll-free number below.

IMPORTANT NOTICE
All new policy loans have a variable interest rate with a minimum rate of 5% and a maximum rate of 12%. The
interest rate may change October of each year. The rate is based on the interest for long term Treasure bonds.
Interest is payable yearly on the anniversary date of the loan.
9. FULL SIGNATURE OF INSURED (Do not print)

10. DATE SIGNED

11. HOW WOULD YOU LIKE TO RECEIVE THIS PAYMENT?
BY CHECK
ADDRESS SHOWN IN BLOCK 3
TEMPORARY ADDRESS SHOWN BELOW
(Please print)

OR

NOTE: (The account must be in the name of the veteran. Direct
Deposit will continue with all future payments to this account. You
must notify us of any changes.
B. TRANSIT/ROUTING NUMBER
A. NAME OF FINANCIAL INSTITUTION

BY DIRECT DEPOSIT

C. DEPOSITOR ACCOUNT NUMBER

D. TELEPHONE NUMBER OF
FINANCIAL INSTITUTION

E. ADDRESS OF FINANCIAL INSTITUTION

F. TYPE OF DEPOSITOR ACCOUNT

CHECKING

IMPORTANT - After this form has been completed and signed, it should be mailed to:
Department of Veterans Affairs
P.O. Box 7327
Philadelphia, PA 19101
NOTE: IF YOU PREFER, INSTEAD OF MAILING THIS FORM, IT MAY BE FAXED TO (215) 381-3580.
PLEASE DO NOT RETURN YOUR POLICY WITH EITHER APPLICATION.

QUESTIONS ABOUT YOUR INSURANCE? CALL US TOLL FREE AT 1-800-669-8477.
VA FORM
JUN 2007

29-1546-1

SUPERSEDES VA FORM 29-1546-1, JUN 2003,
WHICH WILL NOT BE USED.

SAVINGS

OMB Approved No. 2900-0012
Respondent Burden: 10 minutes

APPLICATION FOR CASH SURRENDER
GOVERNMENT LIFE INSURANCE
PRIVACY ACT INFORMATION - We need this information to determine, establish, or verify your eligibility for VA Insurance benefits (38 U.S.C. 5902). Title 38, United States Code, allows
us to ask for this information. We estimate that you will need an average of 10 minutes to review the instructions, find the information, and complete this form. VA cannot conduct or sponsor a
collection of information unless a valid OMB control number is displayed. You are not required to respond to a collection of information if this number is not displayed. Valid OMB control
numbers can be located on the OMB Internet page at www.whitehouse.gov/omb/library/OMBINV.VA.EPA.html#VA. If desired, you can call 1-800-827-1000 to get information on where to
send comments or suggestions about this form.
RESPONDENT BURDEN - The VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of 1974, or Title 5, Code of
Federal Regulations 1.576 for routine uses identified in the VA system of records, 36VA00, Veterans and Armed Forces Personnel U.S. Government Life Insurance Records - VA, published in
the Federal Register. Your obligation to respond is voluntary, but your failure to provide us the information could impede processing. Giving us your SSN account information is voluntary.
Refusal to provide your SSN by itself will not result in the denial of benefits. The VA will not deny an individual benefits for refusing to provide his or her SSN unless the disclosure of the
SSN is required by Federal Statute of law in effect prior to January 1, 1975, and still in effect. The responses you submit are considered confidential (38 U.S.C. 5701).

1. FIRST - MIDDLE - LAST NAME (Type or print)

2. INSURANCE FILE NUMBER

3. PERMANENT MAILING ADDRESS (Must be complete)

4. POLICY NUMBER (Include letter prefix)

F

5. DAYTIME TELEPHONE NUMBER (Include Area Code)

6. SOCIAL SECURITY NUMBER

7. I HEREBY SURRENDER MY: (Check appropriate block)
BASIC INSURANCE POLICY
PAID UP ADDITIONS ONLY

BASIC INSURANCE AND PAID UP ADDITIONS
(USE SURRENDER VALUE TO BUY REDUCED PAID-UP INSURANCE

PARTIAL SURRENDER OF PAID-UP ADDITION (AMOUNT OF CHECK)

$

8. FUTURE DIVIDEND OPTION
PAY TO ME IN CASH

APPLY TO PAY PREMIUMS IN ADVANCE

HOLD ON DIVIDEND CREDIT

APPLY TO PAY INDEBTEDNESS

APPLY TO BUY PAID-UP ADDITIONS

HOLD ON DIVIDEND DEPOSIT

NETCASH

NETLOLI

NETPUA

NET OPTIONS - Dividend pays annual premium and remainder is used to reduce loan (NETLOLI), buy additional insurance (NETPUA), or refunded to veteran (NETCASH).

I hereby surrender all my right, title and interest in the basic insurance policy and/or paid-up additions represented by the policy number shown in
Item 4 for the purpose of obtaining the cash surrender value.
9. FULL SIGNATURE OF INSURED (Do not print)

10. DATE SIGNED

11. HOW WOULD YOU LIKE TO RECEIVE THIS PAYMENT?
BY CHECK

OR

BY DIRECT DEPOSIT

(NOTE: The account must be in the name of the veteran. Direct
Deposit will continue with all future payments to this account. You
must notify us of any changes.

ADDRESS SHOWN IN BLOCK 3

A. NAME OF FINANCIAL INSTITUTION

B. TRANSIT/ROUTING NUMBER

TEMPORARY ADDRESS SHOWN BELOW
(Please print)

C. DEPOSITOR ACCOUNT NUMBER

D. TELEPHONE NUMBER OF
FINANCIAL INSTITUTION

E. ADDRESS OF FINANCIAL INSTITUTION

F. TYPE OF DEPOSITOR ACCOUNT

CHECKING

IMPORTANT - After this form has been completed and signed, it should be mailed to:
Department of Veterans Affairs
P.O. Box 7327
Philadelphia, PA 19101
NOTE: IF YOU PREFER, INSTEAD OF MAILING THIS FORM, IT MAY BE FAXED TO (215) 381-3580.

PLEASE DO NOT RETURN YOUR POLICY WITH THIS APPLICATION
QUESTIONS ABOUT YOUR INSURANCE? CALL US TOLL-FREE AT 1-800-669-8477.
VA FORM
JUN 2007

29-1546-1

SUPERSEDES VA FORM 29-1546-1, JUN 2003,
WHICH WILL NOT BE USED.

SAVINGS