Request for change of
Financial Representative
Metropolitan Life Insurance Company
Things to know before you begin:
ANN-AGENT (03/18)
Page 1 of 2
First name
Middle name Last name
Owner information
Last nameMiddle nameFirst name
Last nameMiddle nameFirst name
Social Security number (last 4 digits)
Phone number Agent ID number
Broker/Dealer name
Client account number (optional)
Contract number(s)
Entity name (if applicable)
SECTION 1: Contract information (Required for all requests)
SECTION 2: New financial representative information
Please note: This form is
not to be used for Custodian-
Owned contracts. (Please
use the Owner/Annuitant
Change form instead.)
• This Request for change of Financial Representative form
is provided for your convenience in changing the financial
representative authorized to service your contract
Joint Owner information (if applicable)
Phone numberDate of birth
Page 2 of 2
FsANN-AGENT (03/18)
Printed name of individual signing above, if different from Contract Owner
(Trustee, Guardian/Conservator, Attorney-In-Fact) (If signer is different than Contract Owner,
additional documentation may be required.)
Last nameMiddle nameFirst name
SECTION 3 - Signature(s)
Regular mail:
P.O. Box 10342
Des Moines, IA 50306-0342
Overnight mail only:
4700 Westown Parkway, Suite 200
West Des Moines, IA 50266
SECTION 4 - How to submit this Form (Please send us the entire form by mail or fax)
Signature of Joint Owner (if applicable)
Date (mm/dd/yyyy)
Signature of Contract Owner
Title (if applicable) Date (mm/dd/yyyy)