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Please select a category from the list below to locate the document you need:

Individual Life

Mail Individual Life forms to:
Great-West Life & Annuity Insurance Company of New York
Administrative Service Office
P.O. Box 2305
Buffalo, NY 14240-2305

Form 57 NY Change of Ownership
Form 58 Change of Joint/Contingent Owner
Form 598 NY Beneficiary Designation
Form 598 NY Massachusetts Beneficiary Designation
Form 1550R NY Loan Request
Form 320 NY Request for Pre-Authorized Check Plan Card
Form 8065 NY Abbreviated Premium Request
Form 51 NY Change of Name
Form 27 NY Policy Service Request
Form 26 NY Policy Change Application
Form 66R NY – Collateral Assignment (use for other than absolute assignment)
Affidavit of Existence of Trust
HIPAA
Form 62 Client Information Sheet for Reinstatement

Fixed Annuity

Mail Fixed Annuity forms to:
Great-West Life & Annuity Insurance Company of New York
Annuity Administration
PO Box 173921
Denver, CO 80217-3921

Form 57 NY Absolute Assignment
Form 58 Change of Joint/Contingent Owner
Form 1070 NY Annuity Minimum Distribution
Form 369 U.S. Direct Deposit
Form 598 NY Beneficiary Designation
Form 598 NY Massachusetts Beneficiary Designation
Form 51 NY Change of Name
Affidavit of Existence of Trust

Variable Annuity

Mail Variable Annuity forms to:
Great-West Life & Annuity Insurance Company of New York
Administrative Service Office
P.O. Box 173920
Denver, CO 80217

Varifund Forms

Form V1008 NY VariFund Financial Service Form
Form V1007 NY Non-Financial Service Form
Form V369 NY Electronic Funds Transfer Request
Form V1039 NY Telephone Transfer Authorization
Form V1006 NY Pre-Authorized Check (PAC) Authorization
Form V1026 NY VariFund Automatic Dollar-Cost-Averaging (DCA) Authorization
Form V1055 NY Substantially Equal Periodic Payments
Form V1070 NY Minimum Distribution Form

Trillium Forms

Form VT1008 NY Trillium Financial Service Form
Form V1007 NY Non-Financial Service Form
Form V369 NY Electronic Funds Transfer Request
Form V1039 NY Telephone Transfer Authorization
Form V1006 NY Pre-Authorized Check (PAC) Authorization
Form VT1026 NY Trillium Automatic Dollar-Cost-Averaging (DCA) Authorization
Form V1055 NY Substantially Equal Periodic Payments
Form V1070 NY Minimum Distribution Form

Products are issued by Great-West Life & Annuity Insurance Company of New York, Home Office: NY, New York, and distributed by its affiliate, GWFS Equities, Inc., the principal underwriter, 8515 East Orchard Road, Greenwood Village, CO 80111, 800-905-1959. You should consider the investment objectives, risks, fees and expenses carefully before investing. Depending upon the investment options offered in the annuity contract, your registered representative can provide you with a consolidated financial statement and portfolio prospectuses for underlying funds. Please read them carefully before investing or sending money.