Service Forms

Additional Forms

• Model Asset Allocation & Investment Advisory Agreement When completing this form, please also review the MSTAR ADV| MSTAR ADV - Morningstar Asset Allocation Program ADV  This form gives information about the investment adviser and its business for the use of clients. The information has not been approved or verified by any government authority.
• Limited Power of Attorney Appointment - Complete this form if the policy will have multiple owners or will be owned by a trust with multiple trustees.
• PIN Authorization Form and E-delivery Election Form (PS3000) - Complete this form to establish a personal identification number (PIN) which you will need to have on-line access to policy values.
• Electronic Funds Transfer Form
• Expense/Disbursement Allocation Form: Use this form to direct systematic deductions be withdrawn from a specific sub-account(s) for PF423 - No Load Variable Annuity
• Third Party Transfer Authorization
  Authorizes a third party to change allocation of premium payments and to transfer funds among sub-accounts.
• Interested Third Party Form Authorization agreement to release policy information to a designated party.
  

Policy Service Forms

• UN 3379 A : Variable - Legal Service Request Form: Beneficiary/Ownership/Successor Ownership/Name Change/Lost Policy Affidavit/Release of Interest
• AG5216 GLWB Change & Withdrawal Request Form

Withdrawal or Surrender Request Forms

• UN5238 Annuity Withdrawal or Surrender Request Form
• UN5238SH1 Safe Harbor Explanation required for Governmental 457 plans
• UN5238SH2 Safe Harbor Explanation required for 401(a), 403(a), or 403(b) plans 
  
  

Optional Investment Strategies & Allocation Change Forms

• PF424 - NLVA
  Request Dollar Cost Averaging, Portfolio Re-balancing or Earnings Sweep.
• PF538 - NLVA
  Allocation Change Form to change current and future allocations or make unscheduled deposits.