Service Forms

You may allocate all or part of your initial purchase payment to the DCA Plus Account.

Use this form to establish the Scheduled Systematic Withdrawal (SSW) from your account, as required by the Internal
Revenue Service for beneficiary accounts.

Use this form to show there is a reasonable basis for believing that the purchase suits your current investment goals and financial situation, and you have been reasonably informed of the terms and features of a variable annuity and would benefit

For establishing privileges to withdraw funds from your contract without incurring a surrender charge penalty, such as for Nursing Home stay or a Terminal Illness diagnosis. Must meet requirements outlined on the form and in your contract.

Use this form to establish a Systematic Transfer Enrollment Program (STEP). Funds invested in the STEP account will be transferred monthly to allocations you select.

For transferring funds from one account to another, completing a one-time Asset Re-balance, changing the allocation of future payments (Change of Future Allocation), or applying for Telephone Exchange Authorization, which allows you to exchange fu

This Trust or Entity Certification Form must be used when a partnership, trust, or other non-natural person(collectively "Entity"), is the owner of the annuity contract.

For use with Vantage only. This form gives authority to another person ("attorney in fact") to act on your behalf for the Contract/Account Number identified below.

For use with Vantage only. For changes to existing contracts only.

For establishing privileges to withdraw funds from your contract without incurring a surrender penalty. Must meet requirements outlined on the form.