Form 29-1546 Application for Cash Surrender or Policy Loan

OMB Control No. 2900-0012
Respondent Burden: 10 minutes
Expiration Date: XXXXXXX

APPLICATION FOR CASH SURRENDER
GOVERNMENT LIFE INSURANCE

PRIVACY ACT INFORMATION: No insurance deduction may be made unless a completed authorization has been received (38 CFR 8.8). The information requested
is required to obtain or retain benefits and will be used by VA employees and your authorized representatives in the maintenance of Government insurance programs.
Responses may be disclosed outside VA only if the disclosure is authorized under the Privacy Act, including the routine uses identified in the VA system of records,
36VA29, Veterans and Uniformed Services Personnel Programs of U.S. Government Life Insurance - VA, published in the Federal Register.
RESPONDENT BURDEN: 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.reginfo.gov/public/do/PRASearch. If
desired, you can call 1-800-827-1000 to get information on where to send comments or suggestions about this form.
1. FIRST-MIDDLE-LAST NAME (Type or print)

2. INSURANCE FILE NUMBER

3. MAILING ADDRESS (Must be completed)

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 box)
BASIC INSURANCE POLICY

BASIC INSURANCE AND PAID-UP ADDITIONS

PAID-UP ADDITIONS ONLY

USE SURRENDER VALUE TO BUY REDUCED PAID-UP INSURANCE

PARTIAL SURRENDER OF PAID-UP ADDITIONS (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

NET CASH

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 - Sign in ink)

10. DATE

11. HOW WOULD YOU LIKE TO RECEIVE THIS PAYMENT?
BY CHECK
(NOTE: If you are currently on Direct Deposit, this will
stop all future payments by electronic transfer until we
receive instructions from you.)

BY DIRECT DEPOSIT (Please attach a voided personal check)
(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.)
A. NAME OF FINANCIAL INSTITUTION

B. TRANSIT/ROUTING NUMBER

C. DEPOSITOR ACCOUNT NUMBER

D. TELEPHONE NUMBER OF FINANCIAL
INSTITUTION

E. ADDRESS OF FINANCIAL INSTITUTION

F. TYPE OF DEPOSITOR ACCOUNT

ADDRESS SHOWN IN ITEM 3

TEMPORARY ADDRESS SHOWN BELOW

(Please print)

CHECKING

The fastest and most secure way to send you application to
VA Insurance is to use our document upload service at
https://insurance.va.gov/home/IDU.

SAVINGS

OR MAIL THE COMPLETED FORM TO:
Veterans Affairs
P.O. Box 7327
Philadelphia, PA 19101

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

29-1546

EXISTING STOCK OF VA FORM 29-1546, JUN 2018,
WILL BE USED.

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

APPLICATION FOR POLICY LOAN
GOVERNMENT LIFE INSURANCE

PRIVACY ACT INFORMATION: No insurance deduction may be made unless a completed authorization has been received (38 CFR 8.8). The information requested
is required to obtain or retain benefits and will be used by VA employees and your authorized representatives in the maintenance of Government insurance programs.
Responses may be disclosed outside VA only if the disclosure is authorized under the Privacy Act, including the routine uses identified in the VA system of records,
36VA29, Veterans and Uniformed Services Personnel Programs of U.S. Government Life Insurance - VA, published in the Federal Register.
RESPONDENT BURDEN: 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.reginfo.gov/public/do/PRASearch. If
desired, you can call 1-800-827-1000 to get information on where to send comments or suggestions about this form.
1. FIRST-MIDDLE-LAST NAME (Type or print)

2. INSURANCE FILE NUMBER

3. MAILING ADDRESS (Must be completed)

4. SOCIAL SECURITY NUMBER

F

5. DAYTIME TELEPHONE NUMBER (Include Area Code)

7. AMOUNT OF LOAN DESIRED (Check one)

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

$

MAXIMUM LOAN

(AMOUNT) OR

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 THE LOAN
PRINCIPAL

APPLY FUTURE DIVIDENDS TO REDUCE LOAN PRINCIPAL
VA COMPENSATION/PENSION: $____________________________

MILITARY RETIREMENT: $___________________________

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 Treasury bonds. Interest is payable yearly
on the anniversary date of the loan.
9. FULL SIGNATURE OF INSURED (Do not print - Sign in ink)

10. DATE

11. HOW WOULD YOU LIKE TO RECEIVE THIS PAYMENT?
BY CHECK
(NOTE: If you are currently on Direct Deposit, this will
stop all future payments by electronic transfer until we
receive instructions from you.)

BY DIRECT DEPOSIT (Please attach a voided personal check)
(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.)
A. NAME OF FINANCIAL INSTITUTION

B. TRANSIT/ROUTING NUMBER

C. DEPOSITOR ACCOUNT NUMBER

D. TELEPHONE NUMBER OF FINANCIAL
INSTITUTION

E. ADDRESS OF FINANCIAL INSTITUTION

F. TYPE OF DEPOSITOR ACCOUNT

ADDRESS SHOWN IN ITEM 3

TEMPORARY ADDRESS SHOWN BELOW

(Please print)

CHECKING

The fastes and most secure way to send you application to
VA Insurance is to use our docment upload service at
https://insurance.va.gov/home/IDU.

SAVINGS

OR MAIL THE COMPLETED FORM TO:
VAROIC
P.O. Box 7327
Philadelphia, PA 19101

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

29-1546

EXISTING STOCK OF VA FORM 29-1546, JUN 2018,
WILL BE USED.