VA Form 29-1546 Application for Cash Surrender or Policy Loan

OMB Control No. 2900-0012
Respondent Burden: 10 minutes
Expiration Date: 01/31/2025

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 POLICY NUMBER (If more than one policy, please
complete a separate form for each policy number)

3. MAILING ADDRESS (Must be completed)

4. DAYTIME TELEPHONE NUMBER (Include Area Code)

5. SOCIAL SECURITY NUMBER

6. 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

7. FUTURE DIVIDEND OPTION
PAY TO ME IN CASH

APPLY TO PAY PREMIUMS IN ADVANCE

HOLD IN DIVIDEND ACCOUNT

APPLY TO PAY INDEBTEDNESS

APPLY TO BUY PAID-UP ADDITIONS

NET PUA

NET CASH

NET LOAN

NET OPTIONS: Dividend pays annual premium and remainder is used to reduce loan (NET LOAN), buy additional insurance (NET PUA), or refunded to veteran
(NET CASH).
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 2 for the
purpose of obtaining the cash surrender value.
8. FULL SIGNATURE OF INSURED (Do not print - Sign in ink)

9. DATE (MM/DD/YYYY)

10. 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(e)-(j) 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:
Veterans Affairs
Insurance is to use our document upload service at
P.O. Box 7327
https://insurance.va.gov/home/IDU.
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
AUG 2022

29-1546

EXISTING STOCKS OF VA FORM 29-1546, JAN 2022.
WILL BE USED.