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Athene Annuity & Life Assurance Company of New York 69 Decker Street Back, New York 10960 SIMPLIFIED ISSUE LIFE APPLICATION FOR REINSTATEMENT THIS FORM MUST BE COMPLETED IN ITS ENTIRETY AND PROPERLY

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What is this form must be?

This form must be a tax form for reporting income.

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Individuals or businesses with taxable income are required to file this form.

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This form must be filled out with accurate and complete information regarding income and deductions.

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The purpose of this form is to report income to the tax authorities for tax assessment and compliance purposes.

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Information such as income, deductions, and tax payments must be reported on this form.

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