Form 1099-LTC

Long-Term Care and Accelerated Death Benefits

Long-term care and accelerated death benefits paid under insurance contracts.

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Issuer / payer

The business or person that paid and is filing this return. Enter either a business name or an individual name.

Foreign entityIssuer TIN *TIN type *Business name controlFirst 4 significant characters of the business name.Business nameBusiness name (line 2)Individual first nameIndividual middle nameIndividual last nameForeign addressCheck to enter a non-US address (country + province + postal code).Address line 1 *Address line 2City *State (US address)Required for a US address.ZIP code (US address)Province / region (foreign)Country code (foreign)Two-letter ISO country code for a foreign address.Postal code (foreign)Phone number

Recipient / payee

The person or business that received the payment. Enter either a business name or an individual name.

Recipient TINTIN typeBusiness name controlBusiness nameBusiness name (line 2)Individual first nameIndividual middle nameIndividual last nameAdditional recipientForeign addressCheck to enter a non-US address (country + province + postal code).Address line 1 *Address line 2City *State (US address)Required for a US address.ZIP code (US address)Province / region (foreign)Country code (foreign)Two-letter ISO country code for a foreign address.Postal code (foreign)Account numberDistinguishes this recipient if you file more than one of the same form for them.

Filing details

Tax year *VoidCorrected

Form 1099-LTC details

1Gross long-term care benefits paid2Accelerated death benefits paid3Per diem3Reimbursed amount4Qualified contract5Insured is chronically ill5Insured is terminally ill5Date certified

Insured (box 3)

The individual insured under the long-term care or life-insurance contract.

Insured TIN *Individual first name *Individual middle nameIndividual last name *SuffixForeign addressCheck to enter a non-US address (country + province + postal code).Address line 1 *Address line 2City *State (US address)Required for a US address.ZIP code (US address)Province / region (foreign)Country code (foreign)Two-letter ISO country code for a foreign address.Postal code (foreign)

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