Common Contracts
22 similar Variable Annuity Application contracts by Minnesota Mutual Variable Annuity Account, Lincoln National Variable Annuity Account H, Variable Annuity Account, others
---------------------------------- City State Zip Home Telephone Number Is Trust revocable* Yes No --- --- ----------------------------------------------------------- ---------------------------------- Trustee Name* Date of Trust*Variable Annuity Application • April 11th, 2012 • Lincoln New York Account N for Variable Annuities
---------------------------------- City State Zip Home Telephone Number Is Trust revocable* Yes No --- --- ----------------------------------------------------------- ---------------------------------- Trustee Name* Date of Trust*Variable Annuity Application • April 11th, 2012 • Lincoln Life & Annuity Variable Annuity Account H
OPTIONAL - COMPLETE ONLY ONE 3A. OWNER-INDIVIDUAL NONQUALIFIED ONLY If other than annuitant/owner. Relationship to Must be at least age 18 (19 in NE & AL, 21 in MS) and no older than age 85 Annuitant ________________________ on the contract issue date.Variable Annuity Application • April 27th, 2007 • Cuna Mutual Life Variable Annuity Account
WILL THE PURCHASE OF THIS ANNUITY RESULT IN THE REPLACEMENT, TERMINATION OR CHANGE IN VALUE OF ANY EXISTING LIFE INSURANCE POLICY FOR ANNUITY CONTRACT IN THIS OR ANY OTHER COMPANY? [ ] Yes [X] No If yes, provide the information below: Use the Special...Variable Annuity Application • November 20th, 2003 • Tic Variable Annuity Separate Account 2002
Plan Type: . Non-Qualified . 408(b) IRA (Traditional) . 401 . 403(b) B/D Client Acct. # (if applicable): . Roth IRA . Simple IRA . SEP-IRA . 457(b) gov . 457(b) non-gov . Other --------------------Variable Annuity Application • June 16th, 2003 • Fkla Variable Annuity Separate Account
|_| Primary |_| Contingent ---------------------------------------------------- ------------------------------------------------------------------------------- - |_| Primary |_| Contingent --------------------------------------------------...Variable Annuity Application • June 9th, 2003 • Travelers Separate Account Nine for Variable Annuities
Joint Owner-Non-Qualified Only ------------------------------------------------ ------------------------------------------------------------------------------- ----- Name (First, Middle Initial, Last) Type: [_] Individual [_] Custodian [_] Trustee Sex...Variable Annuity Application • August 3rd, 2001 • Metropolitan Life Separate Account E • Textile mill products
American Legacy III Plus The Lincoln National Life Variable Annuity Application Insurance Company Fort Wayne, Indiana ----------------------------------------- --------------------------------------- Instructions: Please type or print. ANY ALTERATIONS...Variable Annuity Application • May 24th, 2001 • Lincoln National Variable Annuity Account H
MAILING INSTRUCTIONS: Send this APPLICATIONS WITH PAYMENT (AND/OR ADDITIONAL APPLICATIONS WITHOUT PAYMENT: completed application as follows: PAYMENTS): REGULAR MAIL DELIVERY: Pacific Life Insurance REGULAR MAIL DELIVERY: Pacific Life Company,...Variable Annuity Application • December 7th, 2000 • Separate Account a of Pacific Life Insurance Co
American Legacy III Plus The Lincoln National Life Variable Annuity Application Insurance Company Fort Wayne, Indiana ----------------------------------------- -------------------------------------------------------------------------------...Variable Annuity Application • July 10th, 2000 • Lincoln National Variable Annuity Account H
American Legacy III C Share The Lincoln National Life Variable Annuity Application Insurance Company Fort Wayne, Indiana ----------------------------- -------------------------------------------------------------------------------...Variable Annuity Application • July 10th, 2000 • Lincoln National Variable Annuity Account H
CITY, STATE, ZIP -------------------------------------------------------------- --------------------------------------------------------------------- BENEFICIARY CLASS NAME RELATIONSHIP DATE OF BIRTH SEX SOCIAL SECURITY NUMBER / /M / /F...Variable Annuity Application • May 21st, 1999 • Variable Annuity Account
---------------------------------------------------------------------------------------------------------------- # of Dependents RISK TOLERANCE: (CHECK ONE) TIME HORIZON / / 9-11yrs / / Conservative / / Moderate / / Aggressive / / < 3 yrs / / 4-8 yrs / / 12+ yrs ---------------------------------------------------------------------------------------------------------------- PRIOR INVESTMENT EXPERIENCE / / Mutual Funds / / Limited Partnerships / / Bonds / / Years of Experience / / Annuities / / Stocks / / Options/Futures ----------------------------------------------------------------------------------------------------------------------------------- OWNER/ANNUITANT - I/we represent that the statements and answers in this application are full, complete and true to the SIGNATURES best of my/our knowledge. I/we agree that they are to be considered the basis of any contract issued to me/us. I/we have read and agree with applicable statements.
CITY, STATE, ZIP CITY, STATE, ZIPVariable Annuity Application • March 2nd, 1999 • Variable Annuity Account
CITY, STATE, ZIP CITY, STATE, ZIPVariable Annuity Application • March 1st, 1999 • Variable Annuity Account
INVESTMENT SUMMARY ------------------------------------------------------------ ------------------------------------------------------------------------ 1. Are you an employee of Minnesota Mutual or a subsidiary? / / Yes / / No 2. Are you a spouse or...Variable Annuity Application • April 14th, 1998 • Minnesota Mutual Variable Annuity Account
INVESTMENT SUMMARY ------------------------------------------------------------ ------------------------------------------------------------------------ 1. Are you an employee of Minnesota Mutual or a subsidiary? / / Yes / / No 2. Are you a spouse or...Variable Annuity Application • April 14th, 1998 • Minnesota Mutual Variable Annuity Account
TYPE OF PLAN (PLEASE CHECK ONLY ONE BOX) PURCHASE PAYMENT ACCOUNT ALLOCATION -- ------------------------------------------------------------------------------- --------------------------------------------------- / / Non-Qualified $____________ / /...Variable Annuity Application • April 14th, 1998 • Minnesota Mutual Variable Annuity Account
INVESTMENT SUMMARY ------------------------------------------------------------ ------------------------------------------------------------------------ 1. Are you an employee of Minnesota Mutual or a subsidiary? / / Yes / / No 2. Are you a spouse or...Variable Annuity Application • April 14th, 1998 • Minnesota Mutual Variable Annuity Account
INVESTMENT SUMMARY ------------------------------------------------------------ ------------------------------------------------------------------------ 1. Are you an employee of Minnesota Mutual or a subsidiary? / / Yes / / No 2. Are you a spouse or...Variable Annuity Application • April 14th, 1998 • Minnesota Mutual Variable Annuity Account
X ----------------------------------------------------------------------------- ------------------------------------------------------- THIS APPLICATION BECOMES EFFECTIVE ONLY UPON ITS ACCEPTANCE BY MIMLIC SALES CORPORATION --------...Variable Annuity Application • April 24th, 1997 • Minnesota Mutual Group Variable Annuity Account
EQUITABLE LIFE INSURANCE VARIABLE ANNUITY APPLICATION COMPANY OF IOWA Annuity plan applied for: _________________________ Maturity Date (Date on which benefit payments are to begin.) __/__/__ Purchase Payment $____________ Future Payment(s)...Variable Annuity Application • March 29th, 1996 • Equitable Life Insurance Co of Iowa Separate Account A
Street Address Apt.Variable Annuity Application • March 1st, 1996 • Sep Acct Va K Execannuity of Allmerica Fin Lfe Ins & Ann Co
*Attach required additional forms. _______________________________________________________________________________ 5. INITIAL PAYMENT Initial Payment $ _________________________________________ If IRA or SEP-IRA application, the applicant has received a Disclosure Buyer's Guide and this payment is a (check one): / / Rollover / /Trustee to Trustee Transfer / / Regular or SEP-IRA Payment for Tax Year ___________ _______________________________________________________________________________ 6. REPLACEMENT Will the proposed contract replace or change any existing annuity or insurance policy? / / NO / / YES (If yes, list company name and policy number)
