TEACHERS INSURANCE AND ANNUITY ASSOCIATION OF AMERICA TIAA-CREF LIFE INSURANCE COMPANY. Important Information About Transferring Ownership

Size: px
Start display at page:

Download "TEACHERS INSURANCE AND ANNUITY ASSOCIATION OF AMERICA TIAA-CREF LIFE INSURANCE COMPANY. Important Information About Transferring Ownership"

Transcription

1 Page 1 of 4 Important Information About Transferring Ownership Designating Your Beneficiary An Ownership Transfer does not automatically change the beneficiary. Upon completion of this transfer, the new owner will receive the option to name new beneficiaries. If a change in beneficiary is desired, a Beneficiary Change form must be submitted. Tax Disclaimer There may be tax implications associated with this transfer of ownership. You should consult a tax advisor regarding your potential liability for taxation. Trust Signature Requirement If the current owner and/or new owner is a trust with multiple trustees named, each trustee must sign Section F or Section G, as applicable. If any trustee cannot sign along with the other trustees, a separate notarized signature page can be added. Joint Ownership Please review your life insurance policy or non-qualified annuity contract to verify joint ownership is available. Teachers Insurance and Annuity Association of America ( TIAA ) or TIAA-CREF Life Insurance Company ( TIAA-CREF Life ) will not process your transfer of ownership request if your policy or annuity contract does not contain the joint ownership provision. Please be sure to consult with your attorney about the legal ramification of co-owning property with one or more individuals or business entities. Notwithstanding any statement in this form to the contrary, all of the undersigned individuals are considered owners of the underlying policy or annuity contract. Disclaimer: Increasing or decreasing the number of owners listed on a life insurance policy or non-qualified annuity contract after it has already been issued may result in income and/or gift taxes. TIAA or TIAA-CREF Life is not responsible for the legal implications of your ownership arrangement. Agreement The owner(s) acknowledge that all administrative rights, privileges and responsibilities incident to the management of the policy or annuity contract be vested in one person (the Primary Owner ). Below is a non-cumulative list of policy or annuity contract management rights and privileges that the Primary Owner is vested with. In the event that the Primary Owner predeceases the insured or annuitant, all such rights and privileges will transfer automatically to the next owner listed on page 2, in successive order. Rights vested in the Primary Owner 1. The right to access policy or annuity contract information online; 2. The right to change policy or annuity contract investments; 3. The right to allocate policy or annuity contract cash values between the various investment choices; 4. The right to receive policy or annuity contract statements and all other communications; 5. The responsibility for paying policy premiums; 6. The responsibility to receive lapse notices and general information from TIAA and TIAA-CREF Life and then to communicate that information in a timely manner to the other owners; and 7. The responsibility of any tax reporting forms, along with appropriate tax withholding. Rights retained by all Owners The following list of rights and privileges are retained by all owners (i.e., the Primary Owner and non-primary Owner(s)). All owners must approve the following transactions: 1. The right to surrender the policy or annuity contract; 2. The right to assign, endorse, exchange, or transfer the ownership of the policy or annuity contract; 3. The right to change the beneficiaries; and 4. The right to take loans or withdrawals from the policy or annuity contract. If you have any questions about completing the Transfer of Ownership form or if we can help you in any way, please call the TIAA-CREF Insurance Service Center at , Monday Friday, 8 a.m. 6 p.m. (ET). TI MT F7730 (09/12)

2 Page 2 of 4 Request to Transfer Ownership Please Print in Black or Blue Ink I hereby transfer ownership of Policy or Annuity Contract Number to the New Owner(s) designated below. I understand that the New Owner(s) will have all the rights under the Policy/Annuity Contract. I also understand that this ownership change will be effective when the required documentation is received in good order. Section A: Insured, Annuitant and Current Owner(s) 1. Insured or Annuitant s Full Legal Name (Title, First, Middle, Last, Suffix): 2. Current Owner s Full Legal Name (if different than Insured or Annuitant) (Title, First, Middle, Last, Suffix): 3. Current Joint Owner s Full Legal Name (complete this section for additional owners) (Title, First, Middle, Last, Suffix): 4. Current Trust Name (if applicable): Section B: Primary New Owner (Individual) The Primary owner is the only person who TIAA or TIAA-CREF Life will provide with administrative rights such as: online account access; the right to change investments; the right to allocate cash values between the various investment choices; and the right to receive statements, notices, and all other communications. 1. Full Legal Name (Title, First, Middle, Last, Suffix): 2. Relationship to Current Owner: 3. Taxpayer I.D. or Social Security Number: 4. of Birth: 5. Address: 6. Telephone No. 7. Address (Number and Street): Apt./Suite/Floor: Section C: New Joint Owner (Individual) Please review your life insurance policy or non-qualified annuity contract to verify joint ownership is available. TIAA or TIAA-CREF Life will not process your transfer of ownership request if your policy or annuity contract does not contain the joint ownership provision. 1. Full Legal Name (Title, First, Middle, Last, Suffix): 2. Relationship to Current Owner: 3. Taxpayer I.D. or Social Security Number: 4. of Birth: 5. Address: 6. Telephone No. 7. Address (Number and Street): Apt./Suite/Floor: Section D: New Owner Trust Name (if applicable) Note: When a transfer of ownership is made to a trust, in general, the trust should also be named as beneficiary. Please confer with your tax and/or legal advisor. 1. Name of Trust: 2. of Trust: 3. New Trust Taxpayer I.D.: 4. Trust Address (Number and Street): Apt./Suite/Floor: Section E: New Owner Corporation Name (if applicable) Note: When a transfer of ownership is made to a corporation, in general, the corporation should also be named as beneficiary. Please confer with your tax and/or legal advisor. 1. Name of Corporation: 2. of Incorporation: 3. Corporation Taxpayer I.D.: 4. Name of Corporate Representative: 5. Telephone No.: 6. Corporation Address (Number and Street): Apt./Suite/Floor: TI MT F7730 (09/12)

3 Page 3 of 4 We, the undersigned, fully understand that Transfer of Ownership shall only be complete upon receipt and acceptance, by Teachers Insurance and Annuity Association of America (TIAA) or TIAA-CREF Life Insurance Company (TIAA-CREF Life), of this properly completed Transfer Form. Section F: Current Owner(s) Notary Section I (We) hereby transfer and set over to the New Owner designated above, his or her executors, administrators or assigns, the policy or annuity contract designated above, together with all rights, title and interest therein. d at State of this day of Signature of Owner... Signature of Joint Owner.. Signature of Collateral Assignee.. Signature of Irrevocable Beneficiary Signature of Spouse/Legally recognized domestic partner (required if spouse/domestic partner currently resides or formerly resided in one of the community property states listed below). AZ, CA, ID, LA, NV, NM, TX, WA, WI). Signature(s) of Corporate Representative, Partner or Trustee: State of: County of: SS: ACKNOWLEDGMENT On this day of,, before me personally appeared, to me known and known to be the individual(s) described in and who executed the foregoing transfer of ownership and acknowledged to me that he/she/they executed the same. Seal Notary Public (Signature) My commission expires TI MT F7730 (09/12)

4 Page 4 of 4 Section G: New Owner(s) Notary Section I (We) understand the terms of this transfer, and I (We) agree to accept all rights, title, interest, and obligations of this policy or annuity contract. d at State of This day of Signature of New Owner... Signature of New Joint Owner.. Signature(s) of New Corporate Representative, Partner or Trustee _ State of County of SS: ACKNOWLEDGMENT On this day of,, before me personally appeared, to me known and known to be the individual(s) described in and who executed the foregoing transfer of ownership and acknowledged to me that he/she/they executed the same. Seal Notary Public (Signature) My commission expires (If new owner is a Trust, please complete the enclosed Trustee Declaration of Authority or Trust Declaration and Certification form.) For Company Use Only ACCEPTANCE ACKNOWLEDGMENT TIAA/TIAA-CREF Life Registrar: : SEND COMPLETED FORM TO: TIAA-CREF, INSURANCE SERVICE CENTER, P.O. BOX , ATLANTA, GA TI MT F7730 (09/12)

5 Page 1 of 1 Lost Contract Affidavit Please Print in Black or Blue Ink Contract Number(s) I, (name), certify that each contract listed above by number is not in my possession and I believe that such contract has been either lost or destroyed. To the best of my knowledge and belief, no other person is in possession of these contracts. The purpose of this declaration is to request Teachers Insurance and Annuity Association of America (TIAA) and/or TIAA-CREF Life Insurance Company (TIAA-CREF Life) to accept this declaration instead of the submission of the contracts in connection with the application for benefit payments from these lost contracts. In return, I agree for myself, my heirs, executors, administrators, or assigns to warrant and forever defend TIAA and/or TIAA-CREF Life against any claim resulting from these lost contracts. I also agree to indemnify and hold TIAA and/or TIAA-CREF Life harmless from any claims, demands, suits, liabilities, and any damages to which it may be subject by reason of or in consequence of being obliged to make any payment under these lost contracts. I further agree that these lost contracts shall be of no further value and I agree to return them, if and when found, so that they may be destroyed. I certify that, unless specifically described below, there have been no pledges, transfers, or assignments of these lost contracts. Signature State of County of SS: Subscribed and sworn to before me this (date) Notary Public Signature* *Notary public must include notarial number and the Notarial Number Expiration date appointment expires with this signature. SEND COMPLETED FORM TO: TIAA-CREF, INSURANCE SERVICE CENTER, P.O. BOX , ATLANTA, GA TI IL F4204 (09/12)

6 This page has been intentionally left blank.

7 Trustee Declaration of Authority Form Page 1 of 2 Policy/File Number: Please Print in Black or Blue Ink This form is to be completed in each case in which a trust will own a life insurance policy. Please print clearly. Please attach additional sheets, if needed. Each sheet must be signed and dated by all parties. You do not have to send a copy of your trust document or amendments to the Trust document. However, we reserve the right to request a copy, if needed. Section A: Trust Information 1. Name of Trust: 2. the Trust was signed/created (mm/dd/yyyy): 3. Trust Taxpayer I.D.: 4. State law that governs the trust (this is typically the state in which the trust was created): 5. Trust Correspondence Mailing Address (Provide the address all correspondence should be sent to): Section B: Insured(s) Information 1. Insured s Full Legal Name (First, Middle, Last, Suffix): 2. Insured s Full Legal Name (First, Middle, Last, Suffix): Section C: Trustee(s) Information All new Trustees being added must provide this information. As required by federal law Teachers Insurance and Annuity Association of America (TIAA) or TIAA-CREF Life Insurance Company (TIAA-CREF Life) will use the information provided below to verify your identity. (Note: if additional space is needed, you may attach another page.) Primary Trustee The Primary Trustee is the only person who TIAA or TIAA CREF Life will provide with administrative rights such as: online account access; the right to change policy investments; and the right to allocate policy cash values between the various investment choices. All other non-administrative decisions require sign-off by all trustees. 1. Full Legal Name (First, Middle, Last, Suffix): 2. Taxpayer I.D. or Social Security Number: 3. of Birth: 4. Address: 5. Telephone No.: 6. Address (Number and Street): Apt./Suite/Floor: Trustee 1. Full Legal Name (First, Middle, Last, Suffix): 2. Taxpayer I.D. or Social Security Number: 3. of Birth: 4. Address: 5. Telephone No.: 6. Address (Number and Street): Apt./Suite/Floor: Trustee 1. Full Legal Name (First, Middle, Last, Suffix): 2. Taxpayer I.D. or Social Security Number: 3. of Birth: 4. Address: 5. Telephone No.: 6. Address (Number and Street): Apt./Suite/Floor: TI ITC POS_F1007Life (09/12)

8 Page 2 of 2 Section C: Trustee(s) Information (Cont d) Trustee 1. Full Legal Name (First, Middle, Last, Suffix): 2. Taxpayer I.D. or Social Security Number: 3. of Birth: 4. Address: 5. Telephone No.: 6. Address (Number and Street): Apt./Suite/Floor: The undersigned trustee(s) (the Trustees ) represent and declare that (1) The above-named trust exists and all legal formalities for its establishment under applicable state law have been met, and (2) The Trustees are authorized within the trust to purchase life insurance. The Trustees acknowledge that TIAA or TIAA-CREF Life will recognize the trust as the sole owner of the life insurance policy and that TIAA or TIAA-CREF Life may rely solely on the signature of the Primary Trustee for exercise of all policy administrative rights or options including, but not limited to, any right or option to change the policy investment choices, online policy access, etc. The exercise of all non-administrative rights or options such as the surrender of the policy in whole or in part, policy loans, the assignment of the policy, ownership transfer, etc., will require the signatures of all trustees. The Trustees declare that all current and future trustees are bound by this declaration form, and that TIAA or TIAA-CREF Life may rely on and act at the direction of the Trustees, until TIAA or TIAA-CREF Life receives written notification at its administrative Office, P.O. Box , Atlanta, GA 31139, of a change in the Trustees, change of certain trustee authority or a revocation/termination of the trust. The Trustees agree to make this notification within a reasonable time after such a change and to provide TIAA or TIAA-CREF Life with any other reasonable information upon request. Furthermore, by signing below you are certifying to TIAA or TIAA-CREF Life that (i) you are authorized to act on behalf of the trust, (ii) the information you have supplied above is accurate, (iii) you agree to indemnify and hold TIAA and TIAA-CREF Life harmless for reliance upon this declaration form until such time as further written notification is received from you, (iv) you will notify TIAA or TIAA-CREF Life of any change in Trustees or change in trustee authority, (v) the Primary Trustee named in section C of page 1 will be the only trustee with access to account information online and authorized to request account modifications that are administrative in nature. Section D: Trustee(s) Signature Please have all current acting trustees, with authority to exercise life insurance policy rights, sign and date this form below: X Primary Trustee Signature X Trustee Signature X Trustee Signature X Trustee Signature If corporate trustee, please include official title here: SEND COMPLETED FORM TO: TIAA-CREF, INSURANCE SERVICE CENTER, P.O. BOX , ATLANTA, GA TI ITC POS_F1007Life (09/12)

EASY INSTRUCTIONS FOR CONTRACT CHANGE OR OWNERSHIP AUTHORIZATION REQUEST

EASY INSTRUCTIONS FOR CONTRACT CHANGE OR OWNERSHIP AUTHORIZATION REQUEST EASY INSTRUCTIONS FOR CONTRACT CHANGE OR OWNERSHIP AUTHORIZATION REQUEST Requesting changes to or designating ownership authorization for a contract requires the contract owner's signature. 1. Print, complete,

More information

1035 EXCHANGE / ROLLOVER / TRANSFER FORM

1035 EXCHANGE / ROLLOVER / TRANSFER FORM 1035 EXCHANGE / ROLLOVER / TRANSFER FORM Receiving Company This form can be used to accomplish a FULL or a PARTIAL Exchange of policies pursuant to Internal Revenue Code (IRC) Section 1035. This form can

More information

DESIGNATION OF BENEFICIARY For:

DESIGNATION OF BENEFICIARY For: P.O. Box 1268 Charlotte NC 28201-1268 DESIGNATION OF BENEFICIARY For: Group Supplemental Retirement Annuities Rollover Individual Retirement Annuities Supplemental Retirement Annuities Classic Individual

More information

ASSIGNMENT OF LIFE INSURANCE POLICY AS COLLATERAL

ASSIGNMENT OF LIFE INSURANCE POLICY AS COLLATERAL FORMS 6.3 LOAN DOCUMENTATION MANUAL 249 Form 6.3 ASSIGNMENT OF LIFE INSURANCE POLICY AS COLLATERAL Assignee: Policy Number: Insurer: Insured: Debtor: A. For Value Received, the undersigned hereby assign,

More information

Partial Assignment of Life Insurance Policy as Collateral

Partial Assignment of Life Insurance Policy as Collateral Partial Assignment of Life Insurance Policy as Collateral No assignment of a policy, or of any interest therein, will be binding on the Company unless such assignment, or a signed or certified copy thereof,

More information

New ACORD Form Available for 1035 Exchanges, Rollovers and Direct Transfers

New ACORD Form Available for 1035 Exchanges, Rollovers and Direct Transfers LINCOLN BENEFIT LIFE New ACORD Form Available for 1035 Exchanges, Rollovers and Direct Transfers APRIL 22, 2005 Volume 05-045 IN THIS BULLETIN: Updated ACORD form Lincoln Benefit Life is pleased to announce

More information

Trustee Certification Form

Trustee Certification Form Trustee Certification Form For the CMA Account for Trusts and Individual Investor Account for Trusts Please see instructions for completing this form on page 5. TO: MERRILL LYNCH, PIERCE, FENNER & SMITH

More information

Request for Disbursement / Systematic Withdrawal Form for Qualified Annuities

Request for Disbursement / Systematic Withdrawal Form for Qualified Annuities for Qualified Annuities INSURER Fidelity and Guaranty Life Insurance Company Americom Life and Annuity Insurance Company Service Center: Service Center: PO Box 81497 Lincoln, NE 68501-1497 PO Box 82337

More information

USAA Power of Attorney

USAA Power of Attorney USAA Power of Attorney Important Information. Please Read. General. This USAA POWER OF ATTORNEY is intended to be used by you, to permit another person to conduct most transactions on personal USAA accounts

More information

DESIGNATION OF BENEFICIARY For:

DESIGNATION OF BENEFICIARY For: 730 Third Avenue New York NY 10017-3206 DESIGNATION OF BENEFICIARY For: Group Supplemental Retirement Annuities Rollover Individual Retirement Annuities Supplemental Retirement Annuities Classic Individual

More information

6) Any other form acceptable to the appropriate GAIG company.

6) Any other form acceptable to the appropriate GAIG company. Member Companies: Great American Life Insurance Company Annuity Investors Life Insurance Company Manhattan National Life Insurance Company Administrator for: Loyal American Life Insurance Company United

More information

Items to Note before Selling an Annuity (Fixed Indexed, Fixed and Variable)

Items to Note before Selling an Annuity (Fixed Indexed, Fixed and Variable) Items to Note before Selling an Annuity (Fixed Indexed, Fixed and Variable) In Good Order Requirements To ensure your new business application will be complete and in good order, please provide Security

More information

Items to Note before Selling an Annuity (Fixed Indexed, Fixed and Variable)

Items to Note before Selling an Annuity (Fixed Indexed, Fixed and Variable) Items to Note before Selling an Annuity (Fixed Indexed, Fixed and Variable) In Good Order Requirements To ensure your new business application will be complete and in good order, please provide Security

More information

Items to Note before Selling an Annuity (Fixed Indexed, Fixed and Variable)

Items to Note before Selling an Annuity (Fixed Indexed, Fixed and Variable) Items to Note before Selling an Annuity (Fixed Indexed, Fixed and Variable) In Good Order Requirements To ensure your new business application will be complete and in good order, please provide Security

More information

Minimum Premium: Qualified [$5,000] Non-Qualified [$10,000] Maximum Premium: [$250,000]

Minimum Premium: Qualified [$5,000] Non-Qualified [$10,000] Maximum Premium: [$250,000] 2721 North Central Avenue, Phoenix, Arizona 85004-1172 (866) 641-9999 Oxford Life Insurance Company Single Premium Multi-Year Guarantee Annuity With Market Value Adjustment Feature Benefit Summary and

More information

Beneficiary Change and Predetermined Payout Election Form

Beneficiary Change and Predetermined Payout Election Form Beneficiary Change and Predetermined Payout Election Form Variable Annuities are issued by Pruco Life Insurance Company, in New York, by Pruco Life Insurance Company of New Jersey and The Prudential Insurance

More information

Coverdell Education Savings Account Application

Coverdell Education Savings Account Application Coverdell Education Savings Account Application SSBT Use this application to open a Coverdell Education Savings Account (CESA). Accounts are available only to U.S. citizens and U.S. resident aliens. Please

More information

CANCELLATION AND INDEMNITY AGREEMENT CONCERNING LOST LETTER OF CREDIT

CANCELLATION AND INDEMNITY AGREEMENT CONCERNING LOST LETTER OF CREDIT CANCELLATION AND INDEMNITY AGREEMENT CONCERNING LOST LETTER OF CREDIT This Cancellation and Indemnity Agreement Concerning Lost Letter of Credit (the Cancellation Agreement ) is made and entered into this

More information

Office of the Fiduciary Supervisor Kanawha County Commission P.O. Box 3627, Charleston, WV 25336 (304) 357-0125

Office of the Fiduciary Supervisor Kanawha County Commission P.O. Box 3627, Charleston, WV 25336 (304) 357-0125 Office of the Fiduciary Supervisor Kanawha County Commission P.O. Box 3627, Charleston, WV 25336 (304) 357-0125 Step 3: The Short Form Settlement Dear Personal Representative, Date: RE: Estate of: The

More information

TRS SPECIAL DURABLE POWER OF ATTORNEY

TRS SPECIAL DURABLE POWER OF ATTORNEY TRS SPECIAL DURABLE POWER OF ATTORNEY INFORMATION SHEET PLEASE READ CAREFULLY The following is a Special Durable Power of Attorney prepared by the Teachers Retirement System of the City of New York (TRS)

More information

Items to Note before Selling an Annuity (Fixed Indexed, Fixed and Variable)

Items to Note before Selling an Annuity (Fixed Indexed, Fixed and Variable) Items to Note before Selling an Annuity (Fixed Indexed, Fixed and Variable) In Good Order Requirements To ensure your new business application will be complete and in good order, please provide Security

More information

FAX FAX #: 817-850-9801. From: Phone: 817-850-9800. Company Name: Lincoln Factoring, LLC. Phone: Company Name: Fax: Number of Pages: Date

FAX FAX #: 817-850-9801. From: Phone: 817-850-9800. Company Name: Lincoln Factoring, LLC. Phone: Company Name: Fax: Number of Pages: Date Date FAX FAX #: 817-850-9801 Phone: 817-850-9800 Company Name: Lincoln Factoring, LLC From: Phone: Company Name: Fax: Number of Pages: VERIFICATION FORM FUNERAL HOME CONTACT AMOUNT OF ASSIGNMENT NAME OF

More information

United of Omaha Life Insurance Company A Mutual of Omaha Company

United of Omaha Life Insurance Company A Mutual of Omaha Company United of Omaha Life Insurance Company A Mutual of Omaha Company Change of Ownership/Beneficiary Forms Packet Contains Life Insurance Change of Ownership Form Life Insurance Application for Change of Beneficiary

More information

Institutional Bank Transfer Form

Institutional Bank Transfer Form Institutional Bank Transfer Form Please print clearly in capital letters and black ink. This form is to be used to add U.S. bank account instructions to a Vanguard account(s) and should only be used by

More information

Still the Right Choice

Still the Right Choice American General Life Companies: Still the Right Choice Thank you for being our customer! When you chose an American General Life Companies insurer, you chose the company that would best meet your insurance

More information

EASY SYSTEMATIC PAYMENT (ESP) PROGRAM ELECTION AGREEMENT FOR REQUIRED MINIMUM DISTRIBUTIONS (RMD) (for Qualified Annuity Contracts Over Age 70½ Only)

EASY SYSTEMATIC PAYMENT (ESP) PROGRAM ELECTION AGREEMENT FOR REQUIRED MINIMUM DISTRIBUTIONS (RMD) (for Qualified Annuity Contracts Over Age 70½ Only) Member Companies: Great American Life Insurance Company Administrator for Loyal American Life Insurance Company Annuity Investors Life Insurance Company Administrator for United Teacher Associates Insurance

More information

EASY SYSTEMATIC PAYMENT (ESP) PROGRAM ELECTION AGREEMENT FOR CUSTOMIZED PAYMENT OPTIONS

EASY SYSTEMATIC PAYMENT (ESP) PROGRAM ELECTION AGREEMENT FOR CUSTOMIZED PAYMENT OPTIONS Member Companies: Great American Life Insurance Company Administrator for Loyal American Life Insurance Company Annuity Investors Life Insurance Company Fixed Annuities: PO Box 5420, Cincinnati OH 45201

More information

DURABLE POWER OF ATTORNEY. John Doe

DURABLE POWER OF ATTORNEY. John Doe This document was prepared by: John Doe 100 Main Street Atlanta, Georgia 33034 Return To: John Doe 100 Main Street Atlanta, Georgia 33034 DURABLE POWER OF ATTORNEY OF John Doe I. PRINCIPAL AND ATTORNEY-IN-FACT

More information

INFORMATION AND DOCUMENTATION REQUIRED FOR PETITION FOR UNCLAIMED FUNDS

INFORMATION AND DOCUMENTATION REQUIRED FOR PETITION FOR UNCLAIMED FUNDS INFORMATION AND DOCUMENTATION REQUIRED FOR PETITION FOR UNCLAIMED FUNDS I. A request BY AN OWNER OF RECORD for payment of Unclaimed Funds must include the following documents Petition for Payment of Unclaimed

More information

Security Benefit Advanced Choice Annuity Application Individual Single Purchase Payment Deferred Annuity

Security Benefit Advanced Choice Annuity Application Individual Single Purchase Payment Deferred Annuity Security Benefit Advanced Choice Annuity Application Individual Single Purchase Payment Deferred Annuity Issued by Security Benefit Life Insurance Company. Questions? Call our National Service Center at

More information

Items to Note before Selling an Annuity (Fixed Indexed, Fixed and Variable)

Items to Note before Selling an Annuity (Fixed Indexed, Fixed and Variable) Items to Note before Selling an Annuity (Fixed Indexed, Fixed and Variable) In Good Order Requirements To ensure your new business application will be complete and in good order, please provide Security

More information

CHICAGO TITLE COMPANY

CHICAGO TITLE COMPANY CHICAGO TITLE COMPANY Chicago Title File Number: «Escrow_Number» Timeshare/Vacation Ownership Division 316 W. Mission Avenue, Ste. 121 Escondido, CA 92025 Attention: Name Change Department Telephone: (855)

More information

ALL LOAN BROKERS AND ORIGINATORS DOING BUSINESS IN INDIANA FROM: OFFICE OF SECRETARY OF STATE TODD ROKITA, SECURITIES DIVISION

ALL LOAN BROKERS AND ORIGINATORS DOING BUSINESS IN INDIANA FROM: OFFICE OF SECRETARY OF STATE TODD ROKITA, SECURITIES DIVISION MEMORANDUM TO: ALL LOAN BROKERS AND ORIGINATORS DOING BUSINESS IN INDIANA FROM: OFFICE OF SECRETARY OF STATE TODD ROKITA, SECURITIES DIVISION RE: LICENSING AND REGISTRATION REQUIREMENTS FOR LOAN BROKERS

More information

CONTRIBUTION AGREEMENT of INCROWD ALABAMA FUND I, LLC

CONTRIBUTION AGREEMENT of INCROWD ALABAMA FUND I, LLC CONTRIBUTION AGREEMENT of INCROWD ALABAMA FUND I, LLC INSTRUCTIONS TO INVESTORS EACH PROSPECTIVE INVESTOR IN INCROWD ALABAMA FUND I, LLC (THE COMPANY ) SHOULD EXAMINE THE SUITABILITY OF THIS TYPE OF INVESTMENT

More information

RONALD WASTEWATER DISTRICT 17505 LINDEN AVENUE NORTH - P.O. BOX 33490 SHORELINE WA 98133-0490 (206) 546-2494

RONALD WASTEWATER DISTRICT 17505 LINDEN AVENUE NORTH - P.O. BOX 33490 SHORELINE WA 98133-0490 (206) 546-2494 17505 LINDEN AVENUE NORTH - P.O. BOX 33490 SHORELINE WA 98133-0490 (206) 546-2494 APPLICATION FOR SIDE SEWER CONTRACTOR TO WORK FOR RONALD WASTEWATER DISTRICT 1. Firm name: 2. Name of Principals: 3. Name

More information

Participant Loan Agreement

Participant Loan Agreement Participant Loan Agreement 101 Participant Name Contract Number Daytime Phone Number Zurich American Life Insurance Company (ZALICO) Administrative Offices: PO Box 19097 Greenville, SC 29602-9097 800/449-0523

More information

403(b) Program Highlights

403(b) Program Highlights 403(b) Program Highlights As part of Henry Ford Health System s (HFHS) commitment to helping employees plan for their future financial wellness, HFHS offers a 403(b) program whereby employees can save

More information

SAMPLE DURABLE POWER OF ATTORNEY. John Doe

SAMPLE DURABLE POWER OF ATTORNEY. John Doe This document was prepared by: John Doe 100 Main Street Austin, Texas 80201 Return To: John Doe 555 Simple Street Austin, Texas 80201 DURABLE POWER OF ATTORNEY OF John Doe NOTICE: THE POWERS GRANTED BY

More information

Annuity Withdrawal Request - 457 Deferred Compensation Plan Annuities

Annuity Withdrawal Request - 457 Deferred Compensation Plan Annuities Mailing Instructions: A. Plan/Trust Information Plan/Trust Name: LSW Annuities - Life Insurance Company of the Southwest NL Annuities - National Life Insurance Company PO Box 569080, Dallas, TX 75356 Service:

More information

DURABLE POWER OF ATTORNEY

DURABLE POWER OF ATTORNEY This document was prepared by: John Doe 100 Main Street Miami, Florida 33109 Return To: John Doe 100 Main Street Miami, Florida 33109 DURABLE POWER OF ATTORNEY OF John Doe I. PRINCIPAL AND ATTORNEY-IN-FACT

More information

On Line Banking Agreement and Application for Commercial Accounts

On Line Banking Agreement and Application for Commercial Accounts On Line Banking Agreement and Application for Commercial Accounts You must be an existing Business Account holder of the Belt Valley Bank, hereinafter referred to as Bank, in order to apply for the On

More information

TRANSFERRING YOUR ICMA-RC RETIREMENT PLAN ACCOUNT TO A VANTAGEPOINT IRA

TRANSFERRING YOUR ICMA-RC RETIREMENT PLAN ACCOUNT TO A VANTAGEPOINT IRA TRANSFERRING YOUR ICMA-RC RETIREMENT PLAN ACCOUNT TO A VANTAGEPOINT IRA Included in this brochure: Transfer to Vantagepoint IRA Form Waiver of Qualified Joint and Survivor Annuity Form (for Married 401

More information

Sentinel Security Life Insurance Company

Sentinel Security Life Insurance Company Sentinel Security Life Insurance Company Sentinel Plan Personal Choice Annuity An a la carte solution for a custom annuity Annuities: Sentinel Plan Personal Choice 5 Year Annuity Sentinel Plan Personal

More information

REQUEST FOR DISBURSEMENT Form - Tax-Sheltered Annuities 403(b)

REQUEST FOR DISBURSEMENT Form - Tax-Sheltered Annuities 403(b) Policy Number Owner / Annuitant Phone Number Owner s Legal Address--Street City State Zip CONDITIONS FOR WITHDRAWAL One of the conditions below must be met for a withdrawal to be processed. Please review

More information

WITHDRAWAL/SURRENDER REQUEST FORM

WITHDRAWAL/SURRENDER REQUEST FORM Member Companies: Great American Life Insurance Company Annuity Investors Life Insurance Company Administrator for Life Insurance and Annuities: Loyal American Life Insurance Company United Teacher Associates

More information

OPEN YOUR DEFERRED COMPENSATION ACCOUNT

OPEN YOUR DEFERRED COMPENSATION ACCOUNT OPEN YOUR DEFERRED COMPENSATION ACCOUNT INSTRUCTIONS NEED HELP? Call 800 TIAA-CREF (800 842-2273) Monday to Friday from 8 a.m. to 10 p.m., and Saturday from 9 a.m. to 6 p.m. (ET) or visit tiaa-cref.org.

More information

BENEFICIARY STATEMENT INSTRUCTIONS

BENEFICIARY STATEMENT INSTRUCTIONS Farm Bureau Life Insurance Company 5400 University Avenue West Des Moines, Iowa 50266-5997 800-247-4170 / FAX: 1-800-814-5561 BENEFICIARY STATEMENT INSTRUCTIONS INSTRUCTIONS FOR COMPLETION OF BENEFICIARY

More information

IRA Application For Traditional, ROTH, SEP, and SIMPLE IRAs

IRA Application For Traditional, ROTH, SEP, and SIMPLE IRAs IRA Application For Traditional, ROTH, SEP, and SIMPLE IRAs >> Mail to: Direxion Investments c/o U.S. Bancorp Fund Services, LLC PO Box 701 Milwaukee, WI 53201-0701 Overnight Express Mail To: Direxion

More information

SOUTH CAROLINA STATE BOARD OF COSMETOLOGY

SOUTH CAROLINA STATE BOARD OF COSMETOLOGY SOUTH CAROLINA STATE BOARD OF COSMETOLOGY INSTRUCTIONS FOR SCHOOL APPLICATION YOUR APPLICATION PACKET SHOULD INCLUDE: 1. FLOOR PLANS. 2. SURETY BOND. 3. STUDENT CONTRACT. 4. CURRICULUM. 5. CHECK OR MONEY

More information

WARRANTY DEED INFORMATION PACKET

WARRANTY DEED INFORMATION PACKET WARRANTY DEED INFORMATION PACKET This information can be provided to our customers with the following statement: THERE MAY BE LEGAL AND/OR TAX IMPLICATIONS ONCE THESE FORMS ARE FILED. WE RECOMMEND YOU

More information

A Fraternal Benefit Society Corrections must be initialed by Applicant. 1338 Military Street P.O. Box 5020 Port Huron M148061-5020 PART 1

A Fraternal Benefit Society Corrections must be initialed by Applicant. 1338 Military Street P.O. Box 5020 Port Huron M148061-5020 PART 1 Application for Membership and Single Premium Whole Life Insurance or Annuity Print carefully in Black Ink Woman's Life Insurance Society A Fraternal Benefit Society Corrections must be initialed by Applicant.

More information

IRREVOCABLE LETTER OF CREDIT REIMBURSEMENT AGREEMENT

IRREVOCABLE LETTER OF CREDIT REIMBURSEMENT AGREEMENT 4/1/2015 IRREVOCABLE LETTER OF CREDIT REIMBURSEMENT AGREEMENT THIS AGREEMENT, dated as of, is between, an institution organized and existing under the laws of having its principal office at (the Customer

More information

Legal Assistant Application

Legal Assistant Application PCLR 0.7 Legal Assistant Application 2015 Tacoma-Pierce County Bar Association 621 Tacoma Avenue South, Suite 403 Tacoma, WA 98402 Phone (253) 272-8871, tpcba1@aol.com RULE 0.7 LEGAL ASSISTANTS (a) Authorized

More information

Financial Advisor New Account Application

Financial Advisor New Account Application Financial Advisor New Account Application For Trusts, Partnerships, Corporations, Estates, or Other Entities Complete this application to establish an account for a trust, partnership, corporation, estate,

More information

Part-time Employee Retirement Plan Designation of Beneficiary

Part-time Employee Retirement Plan Designation of Beneficiary Part-time Employee Retirement Plan Designation of Human Resources To the Trustee (s) or Custodian (as applicable) of the Austin Community College Money Purchase Plan Printed Name of Participant I hereby

More information

Fuel Express Commercial Fleet Card Application

Fuel Express Commercial Fleet Card Application Fuel Express Commercial Fleet Card Application 1. Complete all parts of Section 1. 2. Read the attached Commercial Fleet Card Terms and Conditions ( Agreement ) and keep it for your records, along with

More information

New Hanover Regional Medical Center 403(b) and 457(b) Retirement Savings Plans

New Hanover Regional Medical Center 403(b) and 457(b) Retirement Savings Plans New Hanover Regional Medical Center 403(b) and 457(b) Retirement Savings Plans Mutual Fund Safe Harbor Request For Hardship Withdrawal Group ID# 45944003 Group ID# 45944002 1. CLIENT INFORMATION Name:

More information

How To Get Water From A System

How To Get Water From A System WAIVER, RELEASE, INDEMNIFICATION AND HOLD HARMLESS AGREEMENT THIS WAIVER, RELEASE, INDEMNIFICATION AND HOLD HARMLESS AGREEMENT (this Agreement ), made and entered into the day of, 20, by and between THE

More information

Terms & Conditions of Janney Montgomery Scott LLC Transfer on Death ( TOD ) Account Registration

Terms & Conditions of Janney Montgomery Scott LLC Transfer on Death ( TOD ) Account Registration Terms & Conditions of Janney Montgomery Scott LLC Transfer on Death ( TOD ) Account Registration Instructions: Carefully read the Terms & Conditions below and complete all applicable sections of the attached

More information

THE IRREVOCABLE LIFE INSURANCE PRESERVATION TRUST HANDBOOK

THE IRREVOCABLE LIFE INSURANCE PRESERVATION TRUST HANDBOOK THE IRREVOCABLE LIFE INSURANCE PRESERVATION TRUST HANDBOOK This handbook is not to be used in lieu of appropriate legal advice. INSURANCE PRESERVATION TRUST HANDBOOK Page 1 IRREVOCABLE INSURANCE TRUST

More information

For general information regarding requirements for a change of Beneficiary, please see last page of form.

For general information regarding requirements for a change of Beneficiary, please see last page of form. Return: MONY Life Insurance Company of America AXA Equitable Life and Annuity Company Life Insurance Beneficiary Change Traditional and Variable Life Series Express Mail: National Operations Center 8501

More information

Pioneer Investments Retirement Plans

Pioneer Investments Retirement Plans Pioneer Investments Retirement Plans Pioneer Funds Retirement Plans SIMPLE IRA Application It s Easy to Open a Pioneer SIMPLE IRA. 1. Select the Pioneer mutual fund(s) you wish to invest in for your SIMPLE

More information

I/We enclose a fully executed copy of the Trustee Amendment for your records. I/We would also like to provide you with the information listed below.

I/We enclose a fully executed copy of the Trustee Amendment for your records. I/We would also like to provide you with the information listed below. Dear Fidelity Personal Trust Company, FSB: I/We enclose a fully executed copy of the Trustee Amendment for your records. I/We would also like to provide you with the information listed below. 1. Choose

More information

APPLICATION FOR ANNUITY. Proposed Annuitant Name: FIRST MIDDLE LAST. Address: STREET CITY STATE ZIP

APPLICATION FOR ANNUITY. Proposed Annuitant Name: FIRST MIDDLE LAST. Address: STREET CITY STATE ZIP APPLICATION FOR ANNUITY Proposed Annuitant Name: FIRST MIDDLE LAST Address: STREET CITY STATE ZIP Social Security Number: Date of Birth: / / Sex: q Male q Female Proposed Second Annuitant Name: (if applicable

More information

Seneca Mortgage Servicing LLC Attn: Loss Draft Department P.O. Box 52009 Phoenix, AZ 85072. Re: Repair Process. Dear Borrower(s),

Seneca Mortgage Servicing LLC Attn: Loss Draft Department P.O. Box 52009 Phoenix, AZ 85072. Re: Repair Process. Dear Borrower(s), P.O. Box 52009 Phoenix, AZ 85072 Re: Repair Process Dear Borrower(s), Thank you for informing us of the damage to your property. We understand what a difficult time this is for you, and we would like to

More information

UTAH 75-5 DURABLE POWER OF ATTORNEY FORM

UTAH 75-5 DURABLE POWER OF ATTORNEY FORM UTAH 75-5 DURABLE POWER OF ATTORNEY FORM I. NOTICE - This legal document grants you (Hereinafter referred to as the Principal ) the right to transfer unlimited financial powers to someone else (Hereinafter

More information

» Your Permanent street address» A check for your initial investment payable to Calamos Funds

» Your Permanent street address» A check for your initial investment payable to Calamos Funds Mail to: Calamos Family of Funds c/o U.S. Bancorp Fund Services, LLC P. O. Bo 701 Milwaukee, WI 53201-0701 Overnight mail to: Calamos Family of Funds c/o U.S. Bancorp Fund Services, LLC 615 E. Michigan

More information

How To Get A Life Insurance Policy In Gorgonia

How To Get A Life Insurance Policy In Gorgonia Employee Enrollment Application For 51+ Employee s Georgia You, the employee, must complete this application. You are solely responsible for its accuracy and completeness. To avoid the possibility of delay,

More information

Annuity Full Surrender Request

Annuity Full Surrender Request Annuity Full Surrender Request Annuities are issued by Pruco Life Insurance Company, in New York, by Pruco Life Insurance Company of New Jersey and The Prudential Insurance Company of America (PICA) (these

More information

Dealer Application. If Corporation: If Limited Liability Company: If Limited Partnership:

Dealer Application. If Corporation: If Limited Liability Company: If Limited Partnership: Date: 120 Citycentre Drive Cust: Cincinnati, Ohio 45216 Ph: (513) 679-7910 Dealer Application Business Name Address Telephone # Trade Name City State Zip Fax # Dealer Type New Used Franchises Held: Business

More information

Pedicab and Neighborhood Electric Vehicle (NEV) Certificate of Operation Application Guide

Pedicab and Neighborhood Electric Vehicle (NEV) Certificate of Operation Application Guide Pedicab and Neighborhood Electric Vehicle (NEV) Certificate of Operation Application Guide INSTRUCTIONS 1. Fill out application completely. Incomplete applications cannot be processed. 2. The application

More information

Helpful Information for Completing the Authorization for Lifetime Annuity Payments from TIAA-CREF Group/Supplemental Retirement Annuities

Helpful Information for Completing the Authorization for Lifetime Annuity Payments from TIAA-CREF Group/Supplemental Retirement Annuities P.O. Box 1268 Charlotte NC 28201-1268 Helpful Information for Completing the Authorization for Lifetime Annuity Payments from TIAA-CREF Group/Supplemental Retirement Annuities Complete and return this

More information

Pioneer Investments Retirement Plans. Pioneer Investments Retirement Plans

Pioneer Investments Retirement Plans. Pioneer Investments Retirement Plans Pioneer Investments Retirement Plans IRA Application Pioneer Investments Retirement Plans (For Traditional, Rollover, Roth, Beneficiary, Inherited, and SEP IRAs) It s Easy to Open a Pioneer IRA. 1. Select

More information

Request for Disbursement / Systematic Withdrawal Form for Qualified Annuities

Request for Disbursement / Systematic Withdrawal Form for Qualified Annuities for Qualified Annuities INSURER OM Financial Life Insurance Company Policy Number Owner / Annuitant Phone Number Owner s Address--Street City State Zip Check if new address Payment requests will be mailed

More information

PRIVATE PROVIDER REQUIREMENTS General Information and Checklist Rev. 10-01-2014

PRIVATE PROVIDER REQUIREMENTS General Information and Checklist Rev. 10-01-2014 PRIVATE PROVIDER REQUIREMENTS General Information and Checklist Rev. 10-01-2014 The use of Private Providers is authorized by Florida Statute 553.791 (Alternative Plans Review and Inspection). The City

More information

OPEN YOUR RETIREMENT ACCOUNT

OPEN YOUR RETIREMENT ACCOUNT OPEN YOUR RETIREMENT ACCOUNT ENROLLMENT INSTRUCTIONS NEED HELP? Call 800 TIAA-CREF (800 842-2273) Monday to Friday from 8 a.m. to 10 p.m., and Saturday from 9 a.m. to 6 p.m. (ET) or visit tiaa-cref.org.

More information

APPLICATION INSTRUCTIONS

APPLICATION INSTRUCTIONS VANTAGEPOINT PAYROLL DEDUCTION IRA ACCOUNT APPLICATION INSTRUCTIONS Carefully read the instructions before completing the attached application. You may find it helpful to detach the application and refer

More information

HARRIS COUNTY SHERIFF'S DEPARTMENT ATTORNEY'S BAIL BOND APPLICATION 1. NAME OF APPLICANT: BAR CARD # DATE OF BIRTH: DL#

HARRIS COUNTY SHERIFF'S DEPARTMENT ATTORNEY'S BAIL BOND APPLICATION 1. NAME OF APPLICANT: BAR CARD # DATE OF BIRTH: DL# DATE APPLICATION PREPARED: HARRIS COUNTY SHERIFF'S DEPARTMENT ATTORNEY'S BAIL BOND APPLICATION 1. NAME OF APPLICANT: BAR CARD # DATE OF BIRTH: DL# 2. BUSINESS ADDRESS: PHONE # ( ) CITY: ZIP: EMAIL: HOME

More information

JPM FAIR FUND CLAIM FORM

JPM FAIR FUND CLAIM FORM UNITED STATES OF AMERICA SECURITIES AND EXCHANGE COMMISSION JPM FAIR FUND CLAIM FORM Claim Forms may be submitted online by visiting the JPMorgan Chase Non Disclosure Fair Fund ( JPM Fair Fund ) website:

More information

This page left blank intentionally

This page left blank intentionally ATTACHMENT 13 PERFORMANCE AND PAYMENT BONDS This page left blank intentionally RFP #0606-14 Attachment 13: Payment & Performance Bonds Page 1 of 8 PAYMENT BOND (CALIFORNIA PUBLIC WORK) KNOW ALL MEN BY

More information

TRANSFER TO ANOTHER INVESTMENT COMPANY TRANSFER PAYOUT ANNUITY

TRANSFER TO ANOTHER INVESTMENT COMPANY TRANSFER PAYOUT ANNUITY NEED HELP? 800 842-2252 Monday to Friday 8 a.m. 10 p.m. (ET) Saturday 9 a.m. 6 p.m. (ET) Or visit tiaa-cref.org. Have your ID and password ready. WHAT IS A? The Transfer Payout Annuity (TPA) is an option

More information

CARNEGIE MELLON UNIVERSITY FACULTY AND STAFF RETIREMENT PLAN - UNIVERSITY CONTRIBUTIONS

CARNEGIE MELLON UNIVERSITY FACULTY AND STAFF RETIREMENT PLAN - UNIVERSITY CONTRIBUTIONS CARNEGIE MELLON UNIVERSITY FACULTY AND STAFF RETIREMENT PLAN - UNIVERSITY CONTRIBUTIONS OPEN YOUR RETIREMENT ACCOUNT ENROLLMENT INSTRUCTIONS NEED HELP? Call 800 TIAA-CREF (800 842-2273) Monday to Friday

More information

Framewater Business - Writing Up a Contract

Framewater Business - Writing Up a Contract IMPORTANT NOTICE TO ADVISORS! Variable Annuity and Variable Universal Life Contract Notice: Please be advised that prior to submitting a Variable Annuity or Variable Universal Life Contract for management

More information

Important Information about Procedures for Opening a New Account

Important Information about Procedures for Opening a New Account Account Application for a Minor Trust Account Use this form to open a new Plan Account by a Custodian under UGMA/UTMA or a Trustee under a Minor Trust Agreement Questions? Call toll-free 1-877-338-4646

More information

ARKANSAS APPRAISAL MANAGEMENT COMPANY APPLICATION FOR REGISTRATION

ARKANSAS APPRAISAL MANAGEMENT COMPANY APPLICATION FOR REGISTRATION M AMR-1 _ Arkansas Appraiser Licensing and Certification Board : by:_ number:_ Date: ed by: Mailed: ARKANSAS APPRAISAL MANAGEMENT COMPANY APPLICATION REGISTRATION The following information constitutes

More information

Premature: under the age of 59½ Normal: over the age of 59½, includes Required Minimum Distributions (RMD) Disability

Premature: under the age of 59½ Normal: over the age of 59½, includes Required Minimum Distributions (RMD) Disability P 1.800.962.4238 W www.pensco.com Distribution Request 1. ACCOUNT OWNER INFORMATION Please type or print all information requested below. Required fields are denoted by an * (asterisk). *First Name: *MI:

More information

Mailing Address City State Zip Country

Mailing Address City State Zip Country Tax Sheltered Annuity (TSA) Mail or fax completed form to: P.O. Box 1555, Des Moines, IA 50306-1555 Fax: 800 531 0038 Contact us: Annuity Customer Contact Center Tel: 888 266 8489 www.athene.com Athene

More information

FBN Requirements (SB 1467)

FBN Requirements (SB 1467) FBN Requirements (SB 1467) Effective January 1, 2015, pursuant to Senate Bill 1467, the Los Angeles County Registrar/Recorder County Clerk s Office will require a Notarized Affidavit of Identity form to

More information

The Florist Credit Union:

The Florist Credit Union: The Florist Federal Credit Union BUSINESS LOAN APPLICATION I. GENERAL INFORMATION Applicants Name / Borrower (individual business owner or business name): Tax ID Number: Mailing Address: Contact Person:

More information

2. ACCOUNT REGISTRATION AND CUSTOMER IDENTIFICATION INFORMATION

2. ACCOUNT REGISTRATION AND CUSTOMER IDENTIFICATION INFORMATION P.O. Box 8024 Boston, MA 02266-8024 800-222-5852 Overnight Mail: 30 Dan Road Canton, MA 02021-2809 SIMPLE IRA Application! Use this form to establish a SIMPLE IRA account only.! Make check payable to Principal

More information

ASSOCIATED LICENSEE LOAN MODIFICATION CONSULTANT, FORECLOSURE CONSULTANT AND COVERED SERVICE PROVIDER APPLICATION FOR RENEWAL OF LICENSE AND CHECKLIST

ASSOCIATED LICENSEE LOAN MODIFICATION CONSULTANT, FORECLOSURE CONSULTANT AND COVERED SERVICE PROVIDER APPLICATION FOR RENEWAL OF LICENSE AND CHECKLIST STATE OF NEVADA DEPARTMENT OF BUSINESS AND INDUSTRY DIVISION OF MORTGAGE LENDING 1830 College Parkway, Suite 100 Carson City, NV 89706 (775) 684-7060 Fax (775) 684-7061 www.mld.nv.gov ASSOCIATED LICENSEE

More information

IRA Account Application For Traditional, ROTH, SEP, and SIMPLE IRAs

IRA Account Application For Traditional, ROTH, SEP, and SIMPLE IRAs IRA Account Application For Traditional, ROTH, SEP, and SIMPLE IRAs >> Mail to: Capital Advisors c/o U.S. Bancorp Fund Services, LLC PO Box 701 Milwaukee, WI 53201-0701 Overnight Express Mail To: Capital

More information

SERVICE REQUEST FORM

SERVICE REQUEST FORM NAME OF OWNER ADDRESS OF OWNER 1. CHANGE OF NAME: I request that the Company change its records to reflect that on by reason of the name of (marriage, divorce, etc.) was changed to. [ ] Owner [ ] Insured

More information

CALIFORNIA UNIFORM STATUTORY POWER OF ATTORNEY (California Probate Code Section 4401)

CALIFORNIA UNIFORM STATUTORY POWER OF ATTORNEY (California Probate Code Section 4401) CALIFORNIA UNIFORM STATUTORY POWER OF ATTORNEY (California Probate Code Section 4401) NOTICE: THE POWERS GRANTED BY THIS DOCUMENT ARE BROAD AND SWEEPING. THEY ARE EXPLAINED IN THE UNIFORM STATUTORY FORM

More information

TRANSMITTAL INFORMATION For All Business Filings

TRANSMITTAL INFORMATION For All Business Filings TOM SCHEDLER SECRETARY OF STATE STATE OF LOUISIANA SECRETARY OF STATE Commercial Division (225) 925-4704 Fax Numbers (225) 932-5314 Corporations (225) 932-5317 Legal Services (225) 932-5318 UCC TRANSMITTAL

More information

INSTRUCTIONS TO EMPLOYER. What to do when a participant terminates employment

INSTRUCTIONS TO EMPLOYER. What to do when a participant terminates employment INSTRUCTIONS TO EMPLOYER What to do when a participant terminates employment 1. Print the following distribution forms and give them to the terminated participant. The required forms include: a. Instructions

More information

OFFICE OF THE ATTORNEY GENERAL SDCL 37-34-3 BUYING CLUB BOND INSTRUCTIONS

OFFICE OF THE ATTORNEY GENERAL SDCL 37-34-3 BUYING CLUB BOND INSTRUCTIONS OFFICE OF THE ATTORNEY GENERAL SDCL 37-34-3 BUYING CLUB BOND INSTRUCTIONS No bond form other than the one provided by the Office of Attorney General (hereinafter ATG) will be approved by the Attorney General

More information

City of Kennedale c/o Art in the Park 405 Municipal Drive Kennedale, TX 76060

City of Kennedale c/o Art in the Park 405 Municipal Drive Kennedale, TX 76060 Dear Art Festival Applicant: The Art in the Park Committee and the City of Kennedale invite you to apply to participate in the Fifth Annual Art in the Park Arts Festival to be held April 4 6, 2014. Please

More information

Institutional Class Account Application

Institutional Class Account Application U.S. Global Investors Funds Institutional Class Account Application YOUR ORIGINAL SIGNATURE(S) IS(ARE) REQUIRED IN SECTION 9 Accounts must have a valid physical U.S. address and each registered owner(s)

More information

Fill in the necessary information corresponding to the account s owner.

Fill in the necessary information corresponding to the account s owner. IRA APPLICATION It s easy to establish your account. Simply fill out this application, completing all relevant sections, sign in ink and return to: Regular Mail FundX Upgrader Funds c/o US Bancorp Fund

More information