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LINCOLN NATIONAL LIFE INSURANCE COMPANY
eANNUITY APPLICATION
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CONTRACT OWNER: JOINT CONTRACT OWNER: (MAY ONLY BE SPOUSE)
Xxxxxxx Xxxxxxx Xxxx Xxxxxxx
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Full Legal Name Full Legal Name
NOTE: MAXIMUM AGE OF 000-X Xxxxx Xxxxxx 000-X Xxxxx Xxxxxx
CONTRACT OWNER IS 85 ------------------ ------------------
(80 IN PENNSYLVANIA). Street Xxxxxxx Xxxxxx Xxxxxxx
Xxxxxxxx XX 00000 Xxxxxxxx XX 00000
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City State ZIP City State ZIP
xxxxxxxx@xxx.xxx xxxxxxxx@xxx.xxx
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email address email address
Social Security # ###-##-#### Social Security # ###-##-####
Date of Birth: 2/17/1963 Male Date of Birth: 6/8/1968 Female
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ANNUITANT Same as Contract Owner
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PRIMARY BENEFICIARY Contract Owner and Joint Contract Owner
CONTINGENT BENEFICIARY Xxxx Xxxxxxx Relation to Contract Owner: son
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CONTRACT TYPE Non-qualified -- initial contribution
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ALLOCATION After the free look period, please allocate my initial purchase payment of $1,500 as follows:
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LINCOLN NATIONAL FUNDS DELAWARE SERIES
8 % Growth and Income 3 % Global Asset Allocation 20 % Trend
THIS ALLOCATION -- -- --
WILL APPLY TO 0 % Bond 9 % Equity Income 20 % Decatur Total Return
FUTURE PURCHASE -- -- --
PAYMENT UNLESS 0 % Money Market 0 % Aggressive Growth 0 % Global Bond
OTHERWISE -- -- --
SPECIFIED THROUGH 0 % Managed 20 % Capital Appreciation
THE INTERNET -- --
SERVICE CENTER. 20 % Special Opportunities 0 % Social Awareness
-- --
0 % International
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REPLACEMENTS
Will the proposed contract replace any existing annuity or insurance contract (including any Lincoln National Life contracts)
which have been, or are being, reduced in premium amount, placed on paid-up, or surrendered? Yes. Existing company AETNA.
Address 000 Xxxxxxxxxx Xxxxxx, Xxxxxxxx, XX 00000. Policy number 1234567.
Approximate amount $1,500.
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SUITABILITY
Number of dependents: 2 Total family income $150,000 Estimated net worth: $250,000
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Financial Objectives: x Long term growth Maximum capital appreciation Preservation of capital Income
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Contract Owner's occupation: Lawyer
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Name and Address of Contract Owner's Employer: Lincoln Law, 000 Xxxxx Xxxx, Xx. Xxxxx, XX 00000
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Form 28978 Page 1
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LINCOLN NATIONAL LIFE INSURANCE COMPANY
eANNUITY APPLICATION
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INTERNET SERVICE CENTER AND TELEPHONE AUTHORIZATION
I hereby consent to receive all documents, including, without limitation, the annuity contract, required in connection with the
variable annuity through the Internet Service Center. I hereby authorize and direct Lincoln National Life Insurance Company to
accept any instructions received through the Internet Service Center or by telephone from any person who can furnish proper
identification. The undersigned agrees that LNL is not liable for any loss arising from following any such instructions.
Initial of Contract Owner:
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AUTOMATIC BANK DRAFT
TO: Mount Xxxxxx National Bank 123456890
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Bank Name ABA NUMBER
000 Xxxxxxxx Xxxxx Xxxx Xxxxx XX 00000
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Bank street address City State ZIP
Automatic bank draft start date: 06/30/98 9876543 $100.00
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Checking account number Monthly amount
I/We hereby request and authorize you to pay and charge to my/our account checks or electronic fund transfer debits
processed by and payable to the order of Lincoln Life, X.X. Xxx 0000, Xxxx Xxxxx, XX 00000-0000, provided there are
sufficient collected funds in said account to pay the same upon presentation. It will not be necessary for any officer or
employee of Lincoln Life to sign such checks. I/We agree that your rights in respect to each such check shall be the same
as if it were a check drawn on you and signed personally by me/us. This authority is to remain in effect until revoked by
me/us, and until you actually receive such notice I/we agree that you shall be fully protected in honoring any such check
or electronic fund transfer debit. In addition to regular bank draft I/We authorize such ad hoc drafts as are requested
through the Internet Service Center. I/We further agree that if any such check or electronic fund transfer debit be
dishonored, whether with or without cause and whether intentionally or inadvertently, you shall be under no liability
whatsoever even though such dishonor results in the forfeiture of insurance or investment loss to me/us.
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Signature(s) EXACTLY as shown on bank records Signature(s) EXACTLY as shown on bank records
Xxxxxxx Xxxxxxx Date 7/1/1998 Xxxx Xxxxxxx Date 7/1/1998
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Print full legal name(s) Print full legal name(s)
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SIGNATURES
Under penalty of perjury the contract Owner certifies that the social security (or taxpayer ID) is correct as it appears
in this application. I acknowledge receipt of a Prospectus. I agree to accept the copy of the application (without
original signature) delivered to me with the LNL policy as a binding, valid contract. Documents will be considered
delivered when LNL places them in the contract owner's personal folder on the Internet Service Center. I UNDERSTAND ALL
PAYMENTS AND VALUES PROVIDED BY THIS CONTRACT ARE BASED ON THE INVESTMENT EXPERIENCE OF A VARIABLE ACCOUNT AND SO ARE
VARIABLE AND ARE NOT GUARANTEED TO A FIXED DOLLAR AMOUNT.
Application signed at: Fort Xxxxx, IN
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Date 7/1/1998 Date 7/1/1998
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Signature of Annuitant Signature of Contract Owner if other than Annuitant
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Form 28978 Page 2
