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Asset Rebalancing Request (OL2855)

This form may be used to readjust investment allocations by shifting money among subaccounts.

To allocate funds outside of the asset rebalancing process, call our Customer Service Center at 1-800-547-0171 or contact your registered representative.

Form OL2855 (pdf, 57K)

Filling Out the Form

We encourage you to read all instructions carefully.

When filling out this form, be sure to include the contract number, owner's name, owner's Social Security number, owner's phone number and agent's phone number. The form requires the signature of the owner and joint owner (if applicable).

In the subaccount section, the form will prompt you to select a subaccount to rebalance and the percentages you wish to have in each subaccount.

Note: Do not use fractional percentages. The total of allocations must equal 100 percent.

In the rebalance options section of the form, you must select either "Full Rebalance" or "Partial Rebalance." If no choice is made, Phoenix will process as a full rebalance.

You will also need to select a start date and the frequency of rebalancing.

Mailing Instructions

After filling out this form, please return it to:

Phoenix Variable Products Mail Operations
P.O. Box 8027
Boston, MA 02266-8027

Overnight Address
Phoenix Variable Products Mail Operations
30 Dan Road
Canton, MA 02021-2809

To speak to a customer service representative, call: 1-800-541-0171
Hours: Monday - Friday, 8:30 a.m. to 6 p.m. ET

©2001-2016 The Phoenix Companies, Inc.

Insurance and annuities issued by Phoenix Life Insurance Company (PLIC) (East Greenbush, NY), PHL Variable Insurance Company (PHLVIC) (Hartford, CT) and Phoenix Life and Annuity Company (PLAC) (Hartford, CT). PHLVIC is not authorized to conduct business in NY and ME. PLAC is not authorized to conduct business in CA, GA, MA, ME, MN, NH, and NY and not authorized to conduct variable universal life insurance business in ID and LA. The insurers referenced are separate entities and each is responsible only for its own financial condition and contractual obligations.

Securities distributed by 1851 Securities, Inc. (Hartford, CT), member FINRA.

Members of The Phoenix Companies, Inc.

Not all products and services described here are available in all states of the USA.