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Your policy is currently on hold. As a result, the annuity payment information listed below may not be accurate. Please contact Customer Service at 800-800-9534 so that we can discuss your policy.

Policy and Certificate Number:

Annuity Benefit Amount: Next Payment Date:

Annuity Payment Amount: Normal Retirement Date:

Employer's Name:  
Policy and Certificate Number:  
Normal Retirement Date:  
Annuity Option:
Post Retirement Death Benefit:

If you die after your Annuity Commencement Date, your beneficiary will receive a single payment of .

Full Name:     Age:   Gender:  
Joint Annuitant:
Full Name:   Age:   Gender:  
Annuity Benefit Amount:
This is a gross amount and any applicable taxes and/or adjustments are deducted from the annuity amount shown.
Date of First Payment:  
Next Payment Date:  
Payment Details:
Payment Type:  
Payment Frequency:  
Account Type:  
Routing Number:  
Account Number:  

If you wish to update your annuity payment delivery method to be sent electronically to your bank account, please complete and return the Direct Deposit Request form.

Payment Type:  
Payment Frequency:  
Mailed to:  
Income Tax Withholding:
State of Residence:  


If you wish to make changes to your future tax withholding(s), please complete and submit the W-4P form.

To request a duplicate tax statement, please call Pacific Life Customer Service at (800) 800-9534.

Medical Insurance Deduction:  

You currently have no beneficiaries associated with your policy.

To add a beneficiary, please complete the Policy Change Request and submit to Pacific Life. Any questions on how to complete the form or questions about your beneficiaries in general, please call Customer Service at 800-800-9534 (7:30 AM to 4:00 PM CT Monday-Friday).

In the event that no beneficiaries have been designated or that no beneficiaries have been clearly identified, Pacific Life will pay any remaining benefit proceeds to your estate.

Please contact Customer Service at (800) 800-9534 (7:30 AM to 4:00 PM CT Monday-Friday) in order to confirm the beneficiaries on file.