Instructions
Convert your traditional IRA to a Roth IRA by completing the form on this page.
- Complete form
 Provide information according to the instructions on the form.
- Fill out requirements
 Complete owner name, policy number, owner social security number, effective date, tax option, owner signature and date. A conversion from a traditional IRA to a Roth IRA is subject to income tax; we recommend you consult your tax advisor.
- Submit form
 Return the completed forms with any required documents via postal mail, overnight mail or fax to our service center.
 Postal mail
 17勛圖厙 Service Center
 P.O. Box 81497
 Lincoln, NE 68501-1497
 Overnight mail
 17勛圖厙 Service Center
 777 Research Drive
 Lincoln, NE 68521
 Fax
 Annuity Policyholder Services (PHS): 402.328.2266
 Allow 3 business days for faxed documents to enter our processing system.
- Allow 15 days to process
 17勛圖厙 will process the request within 15 business days of receipt of all required information if in good order.
- Confirmation
 A confirmation of this change will be mailed to the owner's address on record upon completion.
Conversion Request Form [ADMIN 5576]
22-0084