Form 29-1546 Application for Cash Surrender or Policy Loan

OMB Control No. 2900-0012
Respondent Burden: 10 minutes
Expiration Date: XX/XX/20XX

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: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control
number. The OMB control number for this project is 2900-0012, and it expires XX/XX/20XX. Public reporting burden for this collection of information is estimated to average 10 minutes per
respondent, per year, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding this burden estimate and any other aspect of this collection of information, including suggestions for reducing the burden, to VA Reports Clearance
Officer at [email protected]. Please refer to OMB Control No. 2900-0012 in any correspondence. Do not send your completed VA Form 29-1546 to this email address.
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

APPLY TO PAY INDEBTEDNESS

APPLY TO BUY PAID-UP ADDITIONS

HOLD IN DIVIDEND DEPOSIT

NET CASH

NET LOAN

NET PUA

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 Insurance is to use our document
upload service at https://insurance.va.gov/home/IDU.

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
XXX XXXX

29-1546

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

OMB Control No. 2900-0012
Respondent Burden: 10 minutes
Expiration Date: XX/XX/20XX

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: An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control
number. The OMB control number for this project is 2900-0012, and it expires XX/XX/20XX. Public reporting burden for this collection of information is estimated to average 10 minutes per
respondent, per year, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of
information. Send comments regarding this burden estimate and any other aspect of this collection of information, including suggestions for reducing the burden, to VA Reports Clearance
Officer at [email protected]. Please refer to OMB Control No. 2900-0012 in any correspondence. Do not send your completed VA Form 29-1546 to this email address.
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. SOCIAL SECURITY NUMBER
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 FUTURE DIVIDENDS TO REDUCE LOAN PRINCIPAL
MILITARY RETIREMENT: $

APPLY EXISTING DIVIDEND TO REDUCE THE LOAN PRINCIPAL
APPLY PART OF EXISTING DIVIDENDS ON ACCOUNT TO REDUCE THE LOAN
AMOUNT: $
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 loan.

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(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 Insurance is to use our document
upload service at https://insurance.va.gov/home/IDU.

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
XXX XXXX

29-1546

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