IRS Form 1099-SB "Seller's Investment in Life Insurance Contract"

What Is IRS Form 1099-SB?

This is a tax form that was released by the Internal Revenue Service (IRS) - a subdivision of the U.S. Department of the Treasury on December 1, 2019. Check the official IRS-issued instructions before completing and submitting the form.

Form Details:

  • A 6-page form available for download in PDF;
  • Actual and valid for filing 2020 taxes;
  • Additional instructions and information can be found on page 4 of the document;
  • Editable, printable, and free;
  • Fill out the form in our online filing application.

Download a fillable version of IRS Form 1099-SB through the link below or browse more documents in our library of IRS Forms.

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Download IRS Form 1099-SB "Seller's Investment in Life Insurance Contract"

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Attention:
Copy A of this form is provided for informational purposes only. Copy A appears in red,
similar to the official IRS form. The official printed version of Copy A of this IRS form is
scannable, but the online version of it, printed from this website, is not. Do not print and file
copy A downloaded from this website; a penalty may be imposed for filing with the IRS
information return forms that can’t be scanned. See part O in the current General
Instructions for Certain Information Returns, available at www.irs.gov/form1099, for more
information about penalties.
Please note that Copy B and other copies of this form, which appear in black, may be
downloaded and printed and used to satisfy the requirement to provide the information to
the recipient.
To order official IRS information returns, which include a scannable Copy A for filing with
the IRS and all other applicable copies of the form, visit www.IRS.gov/orderforms. Click on
Employer and Information
Returns, and we’ll mail you the forms you request and their
instructions, as well as any publications you may order.
Information returns may also be filed electronically using the IRS Filing Information Returns
Electronically (FIRE) system (visit www.IRS.gov/FIRE) or the IRS Affordable Care Act
Information Returns (AIR) program (visit www.IRS.gov/AIR).
See IRS Publications 1141, 1167, and 1179 for more information about printing these tax
forms.
Attention:
Copy A of this form is provided for informational purposes only. Copy A appears in red,
similar to the official IRS form. The official printed version of Copy A of this IRS form is
scannable, but the online version of it, printed from this website, is not. Do not print and file
copy A downloaded from this website; a penalty may be imposed for filing with the IRS
information return forms that can’t be scanned. See part O in the current General
Instructions for Certain Information Returns, available at www.irs.gov/form1099, for more
information about penalties.
Please note that Copy B and other copies of this form, which appear in black, may be
downloaded and printed and used to satisfy the requirement to provide the information to
the recipient.
To order official IRS information returns, which include a scannable Copy A for filing with
the IRS and all other applicable copies of the form, visit www.IRS.gov/orderforms. Click on
Employer and Information
Returns, and we’ll mail you the forms you request and their
instructions, as well as any publications you may order.
Information returns may also be filed electronically using the IRS Filing Information Returns
Electronically (FIRE) system (visit www.IRS.gov/FIRE) or the IRS Affordable Care Act
Information Returns (AIR) program (visit www.IRS.gov/AIR).
See IRS Publications 1141, 1167, and 1179 for more information about printing these tax
forms.
VOID
CORRECTED
4343
ISSUER’S name, street address, city or town, state or province, country, ZIP
1 Investment in contract
OMB No. 1545-2281
or foreign postal code, and telephone no.
1099-SB
Seller’s Investment in
Form
$
Life Insurance
(Rev. December 2019)
2 Surrender amount
Contract
For calendar year
20
$
Copy A
ISSUER’S TIN
SELLER’S TIN
Issuer’s information contact name, street address, city or
town, state or province, country, ZIP or foreign postal code,
For
and telephone no. (if different from ISSUER)
Internal Revenue
SELLER’S name
Service Center
File with Form 1096.
For Privacy Act
and Paperwork
Street address (including apt. no.)
Reduction Act
Notice, see the
current General
City or town, state or province, country, and ZIP or foreign postal code
Instructions for
Certain
Policy number
Information
Returns.
1099-SB
Form
(Rev. 12-2019)
Cat. No. 71384X
www.irs.gov/Form1099SB
Department of the Treasury - Internal Revenue Service
Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page
CORRECTED (if checked)
ISSUER’S name, street address, city or town, state or province, country, ZIP
1 Investment in contract
OMB No. 1545-2281
or foreign postal code, and telephone no.
1099-SB
Seller’s Investment in
Form
$
Life Insurance
(Rev. December 2019)
2 Surrender amount
Contract
For calendar year
20
$
Copy B
ISSUER’S TIN
SELLER’S TIN
Issuer’s information contact name, street address, city or
town, state or province, country, ZIP or foreign postal code,
For Seller
and telephone no. (if different from ISSUER)
This is important tax
SELLER’S name
information and is being
furnished to the IRS. If
you are required to file a
return, a negligence
Street address (including apt. no.)
penalty or other
sanction may be
imposed on you if this
City or town, state or province, country, and ZIP or foreign postal code
item is required to be
reported and the IRS
determines that it has
Policy number
not been reported.
1099-SB
(keep for your records)
Form
(Rev. 12-2019)
www.irs.gov/Form1099SB
Department of the Treasury - Internal Revenue Service
Instructions for Seller
The issuer of an insurance policy must furnish this form to you
Box 1. Shows the issuer’s estimate of your investment in the
upon receiving notice of a transfer of your life insurance
contract (as defined in section 72(e)(6)).
contract in a reportable policy sale under section 6050Y or the
Box 2. Shows the amount that you would have received upon
transfer of your life insurance contract to a foreign person
surrender of the life insurance contract transferred.
reportable under section 6050Y.
Issuer’s information contact name, address, and phone
Seller’s taxpayer identification number (TIN). For your
number. Shows the contact information of the issuer. The
protection, this form may show only the last four digits of your
contact information provided will give you direct access to a
TIN (social security number (SSN), individual taxpayer
person who can answer questions about this form. If blank,
identification number (ITIN), adoption taxpayer identification
the contact information is the same as the ISSUER.
number (ATIN), or employer identification number (EIN)).
Future developments. For the latest developments related to
However, the issuer has reported your complete TIN to the
Form 1099-SB and its instructions, such as legislation enacted
IRS.
after they were published, go to www.irs.gov/Form1099SB.
Policy number. Shows the policy number the life insurance
company assigned to the life insurance contract transferred.
CORRECTED (if checked)
ISSUER’S name, street address, city or town, state or province, country, ZIP
1 Investment in contract
OMB No. 1545-2281
or foreign postal code, and telephone no.
1099-SB
Seller’s Investment in
Form
$
Life Insurance
(Rev. December 2019)
2 Surrender amount
Contract
For calendar year
20
$
Copy C
ISSUER’S TIN
SELLER’S TIN
Issuer’s information contact name, street address, city or
town, state or province, country, ZIP or foreign postal code,
For Issuer
and telephone no. (if different from ISSUER)
For Privacy Act and
SELLER’S name
Paperwork Reduction
Act Notice, see the
current General
Instructions for Certain
Street address (including apt. no.)
Information Returns.
City or town, state or province, country, and ZIP or foreign postal code
Policy number
1099-SB
(keep for your records)
Form
(Rev. 12-2019)
www.irs.gov/Form1099SB
Department of the Treasury - Internal Revenue Service

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