TRUST AS OWNER definition
TRUST AS OWNER. In Nonqualified situations, if the owner is a trust, I/we hereby certify that the trust is solely for the benefit of a natural person and not a Deferred Compensation Plan.
TRUST AS OWNER. In Nonqualified situations, if the owner is a trust, I/we hereby certify that the trust is solely for the benefit of a natural person and not a Deferred Compensation Plan. I/WE UNDERSTAND THE CONTRACT WILL TAKE EFFECT WHEN THE FIRST PURCHASE PAYMENT IS RECEIVED AND THE APPLICATION IS APPROVED IN THE HOME OFFICE OF THE COMPANY. I UNDERSTAND THAT ANNUITY PAYMENTS AND TERMINATION VALUES PROVIDED BY THIS CONTRACT ARE VARIABLE AND ARE NOT GUARANTEED AS TO A FIXED DOLLAR AMOUNT. NO REPRESENTATIVE IS AUTHORIZED TO MAKE CHANGES TO THE CONTRACT OR APPLICATION. I ACKNOWLEDGE RECEIPT OF A CURRENT PROSPECTUS. ------------------------------------------------------------------------------------------------------------------------------------ OWNER'S SIGNATURE CITY, STATE WHERE SIGNED (REQUIRED) DATE ------------------------------------------------------------------------------------------------------------------------------------ JOINT OWNER'S SIGNATURE DATE ==================================================================================================================================== REPRESENTATIVE USE ONLY -------------------------------------------------------------------------------- I acknowledge that all data representations and signatures were recorded by me or in my presence in response to my inquiry and request and that all such representations and signatures are accurate and valid to the best of my knowledge and belief. WILL THE CONTRACT APPLIED FOR REPLACE ANY EXISTING ANNUITY OR LIFE INSURANCE POLICY? [ ] YES [ ] NO ------------------------------------------------------------------------------------------------------------------------------------ REPRESENTATIVE'S NAME (PLEASE PRINT) DATE ------------------------------------------------------------------------------------------------------------------------------------ REPRESENTATIVE'S BUSINESS ADDRESS CITY, STATE, ZIP ------------------------------------------------------------------------------------------------------------------------------------ REPRESENTATIVE'S SIGNATURE SOCIAL SECURITY NUMBER ------------------------------------------------------------------------------------------------------------------------------------ PHONE NUMBER FAX NUMBER LICENSE NUMBER (FLORIDA ONLY) ------------------------------------------------------------------------------------------------------------------------------------ BROKER/DEALER COMMISSION: [ ] A ==============================================================...