Form 29-1546 Application for Cash Surrender or Policy Loan

OMB Control No. 2900-0012
Respondent Burden: 10 minutes
Expiration Date: 1/31/2025

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

F

3. MAILING ADDRESS (Must be completed)

4. POLICY NUMBER (Include letter prefix)
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 (MM/DD/YYYY)

11. PAYMENT INFORMATION
BY DIRECT DEPOSIT (Attaching a voided check helps ensure your information is clear.)

(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.) This
will not change the deposit on VA Compensation or Pension payments.
31 U.S.C. § 3332 mandates all federal payments, except IRS tax refunds, that are made by an agency be made by electronic funds transfer. The term federal payments
include government life insurance benefits payments.
A. NAME OF FINANCIAL INSTITUTION
D. TYPE OF DEPOSITOR ACCOUNT
CHECKING

SAVINGS

B. TRANSIT/ROUTING NUMBER

C. DEPOSITOR ACCOUNT NUMBER

The fastest and most secure way to send your application to VA OR MAIL THE COMPLETED FORM TO:
Insurance is to use our document upload service at
Veterans Affairs
https://insurance.va.gov/home/IDU.
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, JAN 2022,
WILL BE USED.

OMB Control No. 2900-0012
Respondent Burden: 10 minutes
Expiration Date: 1/31/2025

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)

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
MILITARY RETIREMENT: $

VA COMPENSATION/PENSION: $

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 policy.

9. FULL SIGNATURE OF INSURED (Do not print - Sign in ink)

10. DATE (MM/DD/YYYY)

11. PAYMENT INFORMATION
BY DIRECT DEPOSIT (Attaching a voided check helps ensure your information is clear.)

(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.) This
will not change the deposit on VA Compensation or Pension payments.
31 U.S.C. § 3332 mandates all federal payments, except IRS tax refunds, that are made by an agency be made by electronic funds transfer. The term federal payments
include government life insurance benefits payments.
A. NAME OF FINANCIAL INSTITUTION
D. TYPE OF DEPOSITOR ACCOUNT
CHECKING

SAVINGS

B. TRANSIT/ROUTING NUMBER

C. DEPOSITOR ACCOUNT NUMBER

The fastest and most secure way to send your application to VA OR MAIL THE COMPLETED FORM TO:
Insurance is to use our document upload service at
Veterans Affairs
https://insurance.va.gov/home/IDU.
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, JAN 2022,
WILL BE USED.