Form 1098-Q (Rev. April 2025)

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7474

VOID

CORRECTED

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

OMB No. 1545-2234

Qualifying
Form 1098-Q Longevity Annuity
Contract
(Rev. April 2025)
Information
For calendar year
1a Annuity amount on start date
PARTICIPANT’S TIN

$
1b Annuity start date

2 Check if start date may be
accelerated

3 Total premiums

4 FMV of QLAC

$
dd

$
dd

$
dd

$
dd

$
dd

$
dd

$

Form 1098-Q (Rev. 4-2025)

5f June

dd

5h August

dd

5j October

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

dd

$

5k November
Name of plan

dd

$

5i September
Plan number

5d April

$

5g July

Account number (see instructions)

dd

$

5e May

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

5b February

$

5c March
Street address (including apt. no.)

For
Internal Revenue
Service Center

$

5a January

PARTICIPANT’S name

Copy A

5l December

$

dd

www.irs.gov/Form1099

Plan sponsor’s EIN

Cat. No. 67073Z

Do Not Cut or Separate Forms on This Page

www.irs.gov/Form1098Q

—

Department of the Treasury - Internal Revenue Service

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 ISSUER’S TIN
or foreign postal code, and telephone no.

OMB No. 1545-2234

Qualifying
Form 1098-Q Longevity Annuity
Contract
(Rev. April 2025)
Information
1a Annuity amount on start date
For calendar year
PARTICIPANT’S TIN

$
2 If checked, start date may
be accelerated

1b Annuity start date

3 Total premiums

4 FMV of QLAC

$

$

5a January

PARTICIPANT’S name

dd

$
dd

$
dd

$
dd

$
dd

$
dd

$

Form 1098-Q (Rev. 4-2025)

5f June

dd

5h August

dd

5j October

dd

$

5k November
Name of plan

dd

$

5i September
Plan number

5d April

This information is
being furnished
to the IRS.

$

5g July

Account number (see instructions)

dd

$

5e May

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

5b February

$

5c March
Street address (including apt. no.)

Copy B
For Participant

5l December

dd

$

Plan sponsor’s EIN

(Keep for your records)

www.irs.gov/Form1098Q

Department of the Treasury - Internal Revenue Service

Instructions for Participant
The information on this Form 1098-Q is submitted to the IRS
by the issuer of your qualifying longevity annuity contract
(QLAC) to report the status of the contract. Prior to
annuitization, the value of any QLAC held by your plan or
traditional IRA (see section 401(a), 403(a), 403(b), or 408; or
eligible governmental plan under section 457(b)) is not
included when calculating the required minimum distribution
(RMD) from your plan or IRA.
You will receive this statement annually beginning with the
first year in which premiums are paid and ending with the
earlier of the year in which you attain age 85 or die. In the
event of your death, if the sole beneficiary under the contract
is your surviving spouse, this annual statement will be
furnished to your surviving spouse until distributions
commence, or if earlier, the year in which your surviving
spouse dies.
If you have questions about your QLAC, contact the issuer
at the address and phone number shown on the front of the
form.
Account number. May show an account or other unique
number the issuer assigned to distinguish your account.
Participant’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.
Plan number, name, and EIN. Shows, if the contract was
purchased under a plan, the number of the plan, the name of
the plan, and the EIN of the plan sponsor.

Box 1a. Annuity amount on start date. If the payments have
not started, shows the annuity amount payable on start date.
Box 1b. Annuity start date. If the payments have not started,
shows the date on which the annuity is scheduled to start. The
date reported is shown in the format month, day, and year,
mm/dd/yyyy.
Box 2. If checked, shows that the start date may be
accelerated.
Box 3. Shows the cumulative total amount of premiums paid
for the contract. Your cumulative total premiums paid for all
QLACs cannot exceed $200,000. If you have paid more than
that, contact your contract issuer.
Box 4. Shows the fair market value (FMV) of your QLAC as of
December 31 of the reporting year.
Boxes 5a–5l. Show the amount of each premium paid for the
contract and the date each premium payment was made in
the reporting year. If there is more than one payment per
month, the box for that month will include the total payments
for the month and the date of the last payment in the month.
Future developments. For the latest information about
developments related to Form 1098-Q and its instructions,
such as legislation enacted after they were published, go to
www.irs.gov/Form1098Q.
Free File Program. Go to www.irs.gov/FreeFile to see if you
qualify for no-cost online federal tax preparation, e-filing, and
direct deposit or payment options.