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Genworth Financial

Genworth Agent Appointment Forms
Since writing our first policy in 1871 as The Life Insurance Company of Virginia, we've been committed to helping people effectively protect and achieve the comfort of financial security.

See What Genworth Financial And Our Insurance Brokerage System Has To Offer!

Today, even in this challenging environment, Genworth Financial is strategically focused and positioned to provide the stability, confidence and support our policyholders, customers and distributors can rely on now and in the future.

Genworth is headquartered in Richmond, Virginia with a presence in all 50 states. The main locations in the U.S. are:

Brentwood, TN - Lynchburg, VA - Phoenix, AZ - Pleasant Hill, CA - Raleigh, NC - Richmond, VA - San Rafael, CA - Schaumburg, IL - Seattle, WA - Stamford, CT - Washington, DC


Other Genworth Financial Insurance Brokerage Products And Services

Life Insurance


Put to use our tools and calculators to help get the answers you’re looking for—from planning for and using your retirement savings to estimating the amount of life insurance you need.

Retirement Calculators

Retirement Income
This calculator will help you estimate how much monthly income your retirement savings may provide you at a specified retirement age. It also provides a year-by-year break down of retirement savings and distributions.

Retirement Planner
Here, you can help determine what your retirement income needs will be in the future, based on a number of key factors. Each year’s retirement savings balance and withdrawals are illustrated until the end of retirement. Social Security can be included.

Retirement Shortfall
This calculator helps you predict how long your retirement savings will last based on current assumptions. If the calculator projects a shortfall, other options, such as increased savings or delaying the date of your retirement, may be considered.

Life Insurance Calculators

How Much Life Insurance Do I Need?
By entering your current assets, expenses, and income, the calculator will give you an estimate of how much life insurance your family may need. You can also adjust the inflation rate and your expected rate of return to see how these variables can impact your insurance needs.

Life Expectancy
How much you need for retirement depends a great deal on how long you expect to live. This calculator can give you an idea of your life expectancy based on your current age, smoking habits, gender and several other important lifestyle choices.


All the appropriate forms you need to update and maintain your policy and account can be found here—from a simple change of address to declaration of attorney to electronic fund transfers for renewal premiums and more.

Address, name and third party changes
Submit address or name changes for yourself or other parties on your contract, or to add, change or delete a third party listed on your policy to receive billing notices (for use with Life Insurance policies only).

Annuitization request
Request conversion of a deferred annuity to irrevocable payments.

Certification of trustee powers - GLAIC/GLIC/GLICNY
Required to show signing authority for contracts owned by a Trust for Genworth Life and Annuity Insurance Company (GLAIC), Genworth Life Insurance Company (GLIC) and Genworth Life Insurance Company of New York (GLICNY).

Declaration of attorney-in-fact (for use with Life Insurance and Annuities only)
Required to show signing authority for an Attorney-in-Fact acting under a Power of Attorney for the contract owner.

Duplicate contract authorization
Request a duplicate copy of a lost or destroyed policy or contract.

Electronic Funds Transfer (EFT) for direct deposit
Request annuity payments to be deposited directly into your bank account or to update bank account information for policies or contracts currently having payments deposited via electronic funds transfer.

Electronic Funds Transfer (EFT) for renewal premiums
Request automatic withdrawals from your bank account to pay premiums on life or long term care insurance policies, or to update bank account information for policies already drafting premiums.

Health information authorization
Authorize us to share your information with a third party you designate.

Annuity contract change form
Request ownership, payee or beneficiary changes on your annuity contract. Also update your address, notify us of any name changes, or add a third party to your contract.

Ownership, payee and beneficiary designation
Request owner, payee or beneficiary changes on any life insurance policy.

Restricted beneficiary payout designation for variable annuities
Restrict the payout option for any beneficiary of a variable annuity.

Surrender, loan or withdrawal authorization (for Life Insurance policies only) 
Request a loan or withdrawal on your life insurance policy or to request a full surrender of your policy. For annuities, please use either the Fixed annuities withdrawal authorization form or the Variable annuities withdrawal authorization form.

Systematic withdrawal request for variable annuities

Request systematic withdrawals from a variable annuity contract.

Fixed annuities withdrawal authorization
Request a single withdrawal from a fixed annuity or authorize future transactions to be requested over the telephone by you or an authorized family member.

Variable annuities withdrawal authorization
Request a single withdrawal from a variable annuity or authorize future transactions to be requested over the telephone by you or an authorized family member.

Systematic or auto interest withdrawal request for fixed annuities
Request a systematic or auto interest withdrawal from a fixed annuity.

Fixed annuities required minimum distribution authorization
Request a Required Minimum Distribution from a fixed annuity.

Variable annuities required minimum distribution authorization
Request a Required Minimum Distribution from a variable annuity.

Tax withholding for annuity payments
Designate the amount of state and federal taxes you want withheld from your annuity payments.

Beneficiary change for Structured Settlements
Complete a beneficiary change on a Structured Settlement


At Genworth, we want to make it easy for you to file a claim. Here you will find the forms and instructions you need to begin the claims filing process for your annuity, long term care or life insurance.

How To File a Claim

At Genworth, we want to make it easy for you to file a claim. Please choose one of the products below for helpful forms and instructions on how to begin your claims filing process.

Long Term Care Insurance Claims

Life Insurance Claims

Annuity Claims

  With ITT QuickView you can access your pending case updates with Genworth Financial companies, North American, and West Coast Life all in one place.
to Sign Up!


Genworth Life and Annuity Insurance Company
Address1 700 Main Street
Address2 -
City Lynchburg
State VA
Zip 24504
Phone Number -
Fax Number -

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For Your Client

Insurance Brokerage provides you with the latest technology to search for the best term life insurance quote for your client-

Our brokerage spreadsheet quoting system allows you to examine "by underwriting class" all of our top companies as they apply to your specific client needs.

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Get appointed with the company that best suits your clients needs-

Download top brokerage appointment forms-

Get a state specific term
life insurance application-

Insurance brokerage affords the agent an easy way to access all of the forms for all of our companies.

Request state specific brokerage life application forms-

Mail completed forms to -

  Insurance Brokerage America

  National Marketing
  P.O. Box 30248
  Charleston, SC 29417
  800-406-6303     843-769-9804 fax

Product Information Tools

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A Tale Of Two Agents

Captive Agent

An agent working exclusively for a single firm. He or she is obliged to submit business only to that firm, or at least give that firm first rights of refusal on the case.

Captive agents that are non-established are usually paid on a combination of salary and commissions earned from selling the policy contract. Also, the firm usually provides its captive agents with an allowance for office expenses as well as employee benefits such as pensions, life insurance, and health insurance. 

The established captive agent is usually paid exclusively on a commission basis.  This type of agent will tend to have more in-depth knowledge of that firm's policies, however, he or she will hardly ever be equipped to offer the industries' best price on any particular product offering.

Independent Agent Broker

Simply said, independent agents are appointed to sell policies from many insurers. The agent is independent from all the companies thus, the independent agent's responsibility is solely focused on evaluating the client's needs and the pricing of the product chosen.

While searching for the brokerage market's best place for a client's business, independent agents pay all their own expenses and keep their own records and earn their income from brokerage commissions on the policies they sell.

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