Annuity Prospectus Delivery Compliance Form

Annuity Prospectus Delivery Compliance Form
Complete this form to provide your information and preferences for compliant delivery of annuity prospectus documents.
Full Name
First NameLast Name
Email Address
example@example.com
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to Annuity Contract
Preferred Delivery Method
Mailing Address (if Physical Mail selected)
Street Address
Street Address Line 2
CityState / ProvincePostal / Zip Code
Preferred Delivery Timing
If 'On a specific date', please specify
MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Acknowledgment of Prospectus Receipt
Additional Delivery Instructions or Comments
Should be Empty: