1099-SB Seller's Investment in Life Insurance Contract

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4343

VOID

CORRECTED

ISSUER’S name, street address, city or town, state or province, country,
ZIP or foreign postal code, and telephone no.

1 Investment in contract

$
2 Surrender amount

OMB No. 1545-2281
Form

1099-SB

(Rev. April 2025)
For calendar year

Seller’s Investment in
Life Insurance
Contract

$
ISSUER’S TIN

SELLER’S TIN

Issuer’s information contact name, street address, city or
town, state or province, country, ZIP or foreign postal code,
and telephone no. (if different from ISSUER)

Copy A

TREASURY/IRS
AND OMB USE
ONLY DRAFT
January 31, 2025
DO NOT FILE

SELLER’S name

For
Internal Revenue
Service Center

For filing information,
Privacy Act, and
Paperwork
Reduction Act
Notice, see the
General Instructions
for Certain
Information Returns.

Street address (including apt. no.)

City or town, state or province, country, and ZIP or foreign postal code
Policy number

www.irs.gov/Form1099

Form 1099-SB (Rev. 4-2025)

Cat. No. 71384X

www.irs.gov/Form1099SB

Department of the Treasury - Internal Revenue Service

Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page

CORRECTED (if checked)
ISSUER’S name, street address, city or town, state or province, country,
ZIP or foreign postal code, and telephone no.

1 Investment in contract

$
2 Surrender amount

OMB No. 1545-2281
Form

1099-SB

(Rev. April 2025)
For calendar year

Seller’s Investment in
Life Insurance
Contract

$
ISSUER’S TIN

SELLER’S TIN

Issuer’s information contact name, street address, city or
town, state or province, country, ZIP or foreign postal code,
and telephone no. (if different from ISSUER)

Copy B

TREASURY/IRS
AND OMB USE
ONLY DRAFT
January 31, 2025
DO NOT FILE

SELLER’S name

This is important tax
information and is being
furnished to the IRS.
If you are required to file
a return, a negligence
penalty or other sanction
may be imposed on you
if this item is required to
be reported and the IRS
determines that it has
not been reported.

Street address (including apt. no.)

City or town, state or province, country, and ZIP or foreign postal code
Policy number

Form 1099-SB (Rev. 4-2025)

(keep for your records)

For Seller

www.irs.gov/Form1099SB

Department of the Treasury - Internal Revenue Service

Instructions for Seller
The issuer of an insurance policy must furnish this form to you
upon receiving notice of a transfer of your life insurance
contract in a reportable policy sale under section 6050Y or the
transfer of your life insurance contract to a foreign person
reportable under section 6050Y.
Seller’s taxpayer identification number (TIN). For your
protection, this form may show only the last four digits of your
TIN (social security number (SSN), individual taxpayer
identification number (ITIN), adoption taxpayer identification
number (ATIN), or employer identification number (EIN)).
However, the issuer has reported your complete TIN to the
IRS.
Policy number. Shows the policy number the life insurance
company assigned to the life insurance contract transferred.

Box 1. Shows the issuer’s estimate of your investment in the
contract (as defined in section 72(e)(6)).
Box 2. Shows the amount that you would have received upon
surrender of the life insurance contract transferred.
Issuer’s information contact name, address, and phone
number. Shows the contact information of the issuer. The
contact information provided will give you direct access to a
person who can answer questions about this form. If blank,
the contact information is the same as the ISSUER.
Future developments. For the latest developments related to
Form 1099-SB and its instructions, such as legislation enacted
after they were published, go to www.irs.gov/Form1099SB.
Free File Program. Go to https://www.irs.gov/FreeFile to see
if you qualify for no-cost online federal tax preparation,
e-filing, and direct deposit or payment options.

TREASURY/IRS
AND OMB USE
ONLY DRAFT
January 31, 2025
DO NOT FILE