Report a variable life insurance policy and income from the policy in Part 6.

For You, Your Spouse, and Your Dependent Children

Part 6

Report a variable life insurance policy if the total value of the policy was more than $1,000 at the end of the reporting period or if more than $200 in total income was received during the reporting period.  In addition, provide the names of each underlying holding within the policy that individually was worth more than $1,000 at the end of the reporting period.  Income is ordinarily reportable only if also reportable for tax purposes.

Reporting the Overall Variable Life Insurance Policy

Description:  Provide the name of the insurance company issuing the policy and write “variable life.”

EIF:  Select “No” for the first line entry of a variable life policy because the overall policy is an investment vehicle that does not qualify as an excepted investment fund.

Income Type:  If applicable, report the type of income received from the policy during the reporting period.

Income Amount:

(1) Income less than $201:  Leave this field blank.

(2) Dividends, capital gains, interest, rent, or royalties:  Select the category that corresponds to the total amount of income received during the reporting period.

(3) Other income:  Provide the exact amount of income received during the reporting period.

Reporting the Underlying Assets

Description:  Provide the name of the underlying asset.

EIF:  For each underlying asset, indicate whether the asset (1) is an investment vehicle that qualifies as an EIF (“Yes”), (2) is an investment fund that does not qualify as an EIF (“No”), or (3) is not an investment vehicle that holds other assets (“N/A”).  In most cases, an investment fund held within a variable life insurance policy will qualify as an EIF.

Value:  Report the value of the underlying asset by selecting the appropriate category.

Income Amount:  Select the category for “None (or less than $201).”

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