Trust and Other Non-Natural Owner 72(u) Tax Deferred Treatment Certification Form (SSLAN-72(u)) – This form is required only if the owner(s) is a non-natural owner and entitled to the tax-deferral exception, as defined on the form. This form must be completed and signed by all trustees and returned to the Home Office with the application. Trustee Certification of Trust (SSLAN-CERTTRUST-OT) – This form is required only if the contract owner will be a trust. Return this form to the Home Office with the application. This form must be completed by the owner(s) and signed by the owner(s) and agent.
SENTINEL SECURITY LIFE 5 YEAR ANNUITY VERIFICATION
Non-Resident Verification Form (SSLAN-NRV-OT Rev 03/13) – This form is required only if the application is signed in a state other than the owner(s) Resident State. One copy should be left with the applicant and the other returned to the Home Office with the application. Important Notice: Replacement of Life Insurance or Annuities (REP Rev 03/08) – If there is a replacement involved with the application, both copies of the Replacement Notice must be signed by the owner(s) and agent. If the application is faxed the original signed Transfer Request form must be mailed to the Home Office separately. This form must be signed by the owner(s) and returned to the Home Office with the application. The Direct Custodial Transfer side is used for all other transfers including all qualified transfers and non-qualified funds coming from a policy that is not an annuity or life insurance. The 1035 Exchange section is used for non-qualified funds that are currently in an annuity or life insurance policy. 1035 Exchange Request Form/Direct Custodial Transfer Request (SSLAN1035-OT Rev 02/13) – Complete the applicable section of this form if the annuity will be funded with a transfer or 1035 Exchange. This form must be signed by the owner and returned to the Home Office with the application.
IRA Rollover Certification Form (SSLAN-RO-OT) – Complete this form if the annuity will be rolled over from another tax qualified retirement plan.
It must be signed by the owner(s) and returned to the Home Office with the application.
Required Minimum Distribution Disclosure ( SSLAN-RMDDISC-OT) – This form is required only if the owner(s) will reach age 70 1/2 during the guarantee period and has not elected to add the Required Minimum Distribution Rider. Community Property States Spousal Existence/Beneficiary Designation Consent Form ( SSLAN-COMMPROPST-OT) – Spousal consent and signature on this form is required with the application if the client’s spouse is not the sole primary beneficiary and the owner resides in a community property state (AZ, CA, ID, LA, NV, NM, TX, WA, WI). Policy Owner Identification Verification (SSLAN-PIV-OT Rev 02/13) – This form is required with all applications and must be completed and signed by the agent. All pages of this Suitability Questionnaire need to be signed or initialed by the owner(s), and page 3 of 4 must be signed by the agent. Note: Always complete the information for the owner, and joint owner if applicable. It must be completed by the agent and signed by the agent and owner(s). Annuity Suitability Questionnaire (SSLAN-SQ-OT Rev 10/14) – This form is required with all applications.
Please review the information carefully and complete all applicable forms:Īnnuity Application (SSLANAP11-TX) – Complete all applicable sections and sign where indicated. This packet contains the following forms for a Personal Choice Annuity application. SENTINEL SECURITY LIFE INSURANCE COMPANY PO BOX 27248 SALT LAKE CITY, UTAH 84127-0248 STATE OF DOMICILE: UTAHĪgent checklist for completing the Personal Choice Annuity Application
SENTINEL SECURITY LIFE 5 YEAR ANNUITY FREE
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