Common Contracts
6 similar Annuity Application contracts by Variable Annuity Life Insurance Co Separate Account A, American Skandia Life Assur Corp Var Acct B Cl 1 Sub Accts, Minnesota Mutual Group Variable Annuity Account, others
Waddell & Reed Advisors Select Income AnnuitySM] Individual Single Purchase Payment Immediate Variable and/or Fixed Income Annuity Application $35,000 Minimum Purchase Payment Nationwide Life Insurance Company P.O. Box 182449 Columbus, Ohio 43218-2449Annuity Application • September 13th, 2002 • Nationwide Variable Account-12
Exhibit 7 Agency No. ---------------- For Company Use Only No. ----------------------- -------------------------- Pension No. ---------------- Part 1 - Application to the New England Mutual Life Insurance Company for an Annuity...Annuity Application • May 1st, 1998 • New England Variable Annuity Fund I
EXHIBIT 5(a) ANNUITY APPLICATION __________________________________________________________________________ Independence Plus Fixed and Variable Annuity Impact Fixed and Variable Annuity GUP Fixed and Variable Annuity V-Plan Fixed Annuity Please print...Annuity Application • April 27th, 1998 • Variable Annuity Life Insurance Co Separate Account A
EXHIBIT 5(a) ANNUITY APPLICATION __________________________________________________________________________ Independence Plus Fixed and Variable Annuity Impact Fixed and Variable Annuity GUP Fixed and Variable Annuity V-Plan Fixed Annuity Please print...Annuity Application • April 27th, 1998 • Variable Annuity Life Insurance Co Separate Account A
H. SIGNATURES ----------------------------------------------------------------- ------------------------------------------------------------------ I represent that the statements and answers in this application are full, complete and true to the best...Annuity Application • April 10th, 1998 • Minnesota Mutual Group Variable Annuity Account
Sex Male Female Date of Birth Sex Male Female Date of Birth Social Security/Tax I.D. No. Social Security/Tax I.D. No. --------------------------------------------------------------- -------------------------------------------------------------------...Annuity Application • March 2nd, 1998 • American Skandia Life Assur Corp Var Acct B Cl 1 Sub Accts
Agreement I/We represent to the best of my/our knowledge and belief the statements made in this application are true and complete; including, under penalty of perjury, the Social Security or Tax ID numbers provided. It is indicated and agreed that the only statements which are to be construed as the basis of the contract are those contained in this application or in any amendment to this application. I/WE HAVE ALSO RECEIVED A COPY OF THE PROSPECTUS AND I/WE UNDERSTAND THAT: (A) ANNUITY PAYMENTS OR SURRENDER VALUES, WHEN BASED ON THE INVESTMENT EXPERIENCE OF THE SEPARATE ACCOUNT, ARE VARIABLE AND NOT GUARANTEED AS TO A DOLLAR AMOUNT; AND (B) ALL PAYMENTS AND VALUES BASED ON THE FIXED ACCOUNT ARE SUBJECT TO A MARKET VALUE ADJUSTMENT FORMULA, THE OPERATION OF WHICH MAY RESULT IN EITHER AN UPWARD OR DOWNWARD ADJUSTMENT. Signatures Owner(s) X /s/John Doe Proposed Annuitant (if other than Owner) X Dated at (location) Anytown, Anystate Date 01/03/92 Signature of Agent X /s/ Robert Smith Agent
