0425 Form 1098-Q (PDF) — verbatim text

Official source: IRS Forms, Instructions & Publications (https://www.irs.gov/pub/irs-pdf/f1098q.pdf), retrieved 2026-10-03. U.S. Government work (17 U.S.C. § 105).

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 IRS.gov/Form1099, for more information about penalties.

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Qualifying

Contract Information

Copy A

For Internal Revenue

Service Center

For filing information,

Privacy Act, and Paperwork Reduction

Act Notice, see the General Instructions

for Certain Information Returns .

www.irs.gov/Form1099

7474 VOID CORREC		CTED
ISSUER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.	ISSUER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.	ISSUER’S TIN	ISSUER’S TIN	Form1098-Q (Rev. April 2025) OMB No. 1545-2234	Form1098-Q (Rev. April 2025) OMB No. 1545-2234
ISSUER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.	ISSUER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.	PARTICIPANT’S TIN	PARTICIPANT’S TIN	PARTICIPANT’S TIN	PARTICIPANT’S TIN
ISSUER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.	ISSUER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.	1aAnnuity amount on start date $	1aAnnuity amount on start date $	For calendar year	For calendar year
ISSUER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.	ISSUER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.	1b Annuity start date	1b Annuity start date	2 Check if start date may be accelerated	2 Check if start date may be accelerated

		3 Total premiums $	3 Total premiums $	4FMV of QLAC $	4FMV of QLAC $
PARTICIPANT’S name	PARTICIPANT’S name	5aJanuary $	dd	5bFebruary $	dd
PARTICIPANT’S name	PARTICIPANT’S name	5cMarch $	dd	5dApril $	dd
Street address (including apt. no.)	Street address (including apt. no.)	Street address (including apt. no.)	Street address (including apt. no.)	Street address (including apt. no.)	Street address (including apt. no.)
Street address (including apt. no.)	Street address (including apt. no.)	5eMay $	dd	5fJune $	dd
Street address (including apt. no.)	Street address (including apt. no.)	5gJuly $	dd	5hAugust $	dd
City or town, state or province, country, and ZIP or foreign postal code
City or town, state or province, country, and ZIP or foreign postal code	City or town, state or province, country, and ZIP or foreign postal code	5iSeptember $	dd	5jOctober $	dd
Account number (see instructions)	Plan number	Plan number	Plan number	Plan number	Plan number
Account number (see instructions)	Plan number	5kNovember $	dd	5lDecember $	dd
Name of plan	Plan sponsor’s EIN	Plan sponsor’s EIN	Plan sponsor’s EIN	Plan sponsor’s EIN	Plan sponsor’s EIN

Do Not Cut or Separate Forms on This Page — Do Not Cut or Separate Forms on This Page

Cat. No. 67073Z

Department of the Treasury - Internal Revenue Service

CORRECTED (if checked)

Qualifying

Contract Information

Copy B For Participant

This information is

being furnished

to the IRS.

ISSUER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.		ISSUER’S TIN		OMB No. 1545-2234 1098-Q Form (Rev. April 2025)
ISSUER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.	ISSUER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.	PARTICIPANT’S TIN	PARTICIPANT’S TIN	PARTICIPANT’S TIN	PARTICIPANT’S TIN
ISSUER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.	ISSUER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.	1aAnnuity amount on start date $	1aAnnuity amount on start date $	For calendar year	For calendar year
ISSUER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.	ISSUER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.	1b Annuity start date	1b Annuity start date	2 If checked, start date may be accelerated	2 If checked, start date may be accelerated

		3 Total premiums $	3 Total premiums $	4FMV of QLAC $	4FMV of QLAC $
PARTICIPANT’S name	PARTICIPANT’S name	5aJanuary $	dd	5bFebruary $	dd
PARTICIPANT’S name	PARTICIPANT’S name	5cMarch $	dd	5dApril $	dd
Street address (including apt. no.)	Street address (including apt. no.)	Street address (including apt. no.)	Street address (including apt. no.)	Street address (including apt. no.)	Street address (including apt. no.)
Street address (including apt. no.)	Street address (including apt. no.)	5eMay $	dd	5fJune $	dd
Street address (including apt. no.)	Street address (including apt. no.)	5gJuly $	dd	5hAugust $	dd
City or town, state or province, country, and ZIP or foreign postal code
City or town, state or province, country, and ZIP or foreign postal code	City or town, state or province, country, and ZIP or foreign postal code	5iSeptember $	dd	5jOctober $	dd
Account number (see instructions)	Plan number	Plan number	Plan number	Plan number	Plan number
Account number (see instructions)	Plan number	5kNovember $	dd	5lDecember $	dd
Name of plan	Plan sponsor’s EIN	Plan sponsor’s EIN	Plan sponsor’s EIN	Plan sponsor’s EIN	Plan sponsor’s EIN

Department of the Treasury - Internal Revenue Service

Instructions for Participant

The information on this Form 1098-Q is submitted to the IRS by the issuer of your qualifying longevity annuity contract (QLAC) to report the status of the contract. Prior to annuitization, the value of any QLAC held by your plan or traditional IRA (see section 401(a), 403(a), 403(b), or 408; or eligible governmental plan under section 457(b)) is not included when calculating the required minimum distribution (RMD) from your plan or IRA.

You will receive this statement annually beginning with the first year in which premiums are paid and ending with the earlier of the year in which you attain age 85 or die. In the event of your death, if the sole beneficiary under the contract is your surviving spouse, this annual statement will be furnished to your surviving spouse until distributions commence, or if earlier, the year in which your surviving spouse dies.

If you have questions about your QLAC, contact the issuer at the address and phone number shown on the front of the form.

Account number. May show an account or other unique number the issuer assigned to distinguish your account.

Participant’s taxpayer identification number (TIN). For your protection, this form may show only the last four digits of your TIN (social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN)). However, the issuer has reported your complete TIN to the IRS.

Plan number, name, and EIN. Shows, if the contract was purchased under a plan, the number of the plan, the name of the plan, and the EIN of the plan sponsor.

Box 1a. Annuity amount on start date. If the payments have not started, shows the annuity amount payable on start date.

Box 1b. Annuity start date. If the payments have not started, shows the date on which the annuity is scheduled to start. The date reported is shown in the format month, day, and year, mm/dd/yyyy.

Box 2. If checked, shows that the start date may be accelerated.

Box 3. Shows the cumulative total amount of premiums paid for the contract. Your cumulative total premiums paid for all QLACs cannot exceed $200,000. If you have paid more than that, contact your contract issuer.

Box 4. Shows the fair market value (FMV) of your QLAC as of December 31 of the reporting year.

Boxes 5a–5l. Show the amount of each premium paid for the contract and the date each premium payment was made in the reporting year. If there is more than one payment per month, the box for that month will include the total payments for the month and the date of the last payment in the month.

Future developments. For the latest information about developments related to Form 1098-Q and its instructions, such as legislation enacted after they were published, go to www.irs.gov/Form1098Q.

Free File Program. Go to www.irs.gov/FreeFile to see if you qualify for no-cost online federal tax preparation, e-filing, and direct deposit or payment options.

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