MetLife Insurance Company

US Business - Annuity & Retirement Services

PO Box 14710 Lexington, KY 40512-4710
Facsimile: 1-859-825-6700

INVE

INCOME VERIFICATION REQUEST


Todays Date:

Annuity/Certificate # _____________________ (If unknown, leave blank.)

Please accept this as a formal request for an income verification letter to be sent to the
address listed below for the above referenced structured settlement annuity.

If the address on this form differs from the address on file, I authorize MetLife to change
my address of record to the address listed below.

If no address is provided below, I authorize MetLife to send my income verification letter
to the address on file.

(Please Print):

Annuitant Name

Annuitants Street Address ______

City, State, Zip Code ______

Annuitants Social Security Number ______

Annuitants Date of Birth _________________________________________________

Authorized Signature _____________________________________________________

Relationship to Annuitant ___________________________________________



Please send signed and completed form to one of the following:


Mailing Address: Overnight Address: Facsimile
MetLife MetLife 1-859-825-6700
PO Box 14710 2025 Leestown Road Suite J
Lexington, KY 40512-4710 Lexington, KY 40511-1000