0425 Form 1099-SB (PDF) — verbatim text

Official source: IRS Forms, Instructions & Publications (https://www.irs.gov/pub/irs-pdf/f1099sb.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.

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.

If you have 10 or more information returns to file, you may be required to file e-file. Go to IRS.gov/InfoReturn for e-file options.

If you have fewer than 10 information returns to file, we strongly encourage you to e-file. If you want to file them on paper, you can place an order for the official IRS information returns, which include a scannable Copy A for filing with the IRS and all other applicable copies of the form, at IRS.gov/EmployerForms. We’ll mail you the forms you request and their instructions, as well as any publications you may order.

See Publications 1141, 1167, and 1179 for more information about printing these forms.

Life Insurance

Contract

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

4343 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.	1 Investment in contract $	Form1099-SB (Rev. April 2025) OMB No. 1545-2281
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.	2 Surrender amount $	2 Surrender amount $
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.	2 Surrender amount $	For calendar year
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, and telephone no. (if different from ISSUER)	Issuer’s information contact name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. (if different from ISSUER)
SELLER’S name	SELLER’S name	SELLER’S name	SELLER’S name
Street address (including apt. no.)	Street address (including apt. no.)	Street address (including apt. no.)	Street address (including apt. no.)
City or town, state or province, country, and ZIP or foreign postal code
Policy number	Policy number

Form 1099-SB (Rev. 4-2025) 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

Cat. No. 71384X

Department of the Treasury - Internal Revenue Service

Life Insurance

Contract

Copy B For Seller

This is important tax information and is being

furnished to the IRS. If you are required to file

a return, a negligence penalty or other sanction

may be imposed on you if this item is required to be reported and the IRS

determines that it has

not been reported.

ISSUER’S name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no.		1 Investment in contract $	OMB No. 1545-2281 1099-SB 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.	2 Surrender amount $	2 Surrender amount $
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.	2 Surrender amount $	For calendar year
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, and telephone no. (if different from ISSUER)	Issuer’s information contact name, street address, city or town, state or province, country, ZIP or foreign postal code, and telephone no. (if different from ISSUER)
SELLER’S name Street address (including apt. no.) City or town, state or province, country, and ZIP or foreign postal code
Policy number	Policy number

Form 1099-SB (Rev. 4-2025) (keep for your records) 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 upon receiving notice of a transfer of your life insurance contract in a reportable policy sale under section 6050Y or the transfer of your life insurance contract to a foreign person reportable under section 6050Y. Seller’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. Policy number. Shows the policy number the life insurance company assigned to the life insurance contract transferred.

Box 1. Shows the issuer’s estimate of your investment in the contract (as defined in section 72(e)(6)). Box 2. Shows the amount that you would have received upon surrender of the life insurance contract transferred. Issuer’s information contact name, address, and phone number. Shows the contact information of the issuer. The contact information provided will give you direct access to a person who can answer questions about this form. If blank, the contact information is the same as the ISSUER. Future developments. For the latest developments related to Form 1099-SB and its instructions, such as legislation enacted after they were published, go to www.irs.gov/Form1099SB . Free File Program. Go to https://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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