Beneficiary Designation With a Preselected Death …

1 X4219 10/041 of 4 What is a Beneficiary Designation with a Preselected Death benefit election?As the Owner(s) of an annuity contract, you have the right to designate a Beneficiary (ies) to be the recipient of your contract benefits at your Death . By designating a Beneficiary (ies), you ensure that the Death benefit of your contract will pass to that indi-vidual(s) without probate. The general provisions of your annuity contract give the Beneficiary (ies) choices ranging from an imme-diate lump-sum distribution to a variety of income streams payable for a period of years not to exceed the Beneficiary s(ies ) lifeexpectancy.

2 Until now, the Contract Owner(s) had no control over which Death Benefit Distribution Option the Beneficiary (ies)chose. The Beneficiary Designation with a Preselected Death Benefit Electionform gives the Contract Owner(s) the ability to electhow their Beneficiary (ies) will receive the Death benefit value of the should you consider a Preselected Death benefit election?The Preselected Death benefit election will allow you to: Continue to take care of your loved ones after you are gone. Select a payout method for your Beneficiary (ies) who does (do) not have the investment savvy to manage his or her finances.

3 Assist a special-needs Beneficiary with an income stream. Accomplish other goals that may be relevant to your particular should this form be completed?The Beneficiary Designation with a Preselected Death Benefit Electionform can be completed at any time prior to the ContractOwner s Death . It can be submitted with an application for a new contract, or as a Beneficiary change request on an existing contract. This will revoke and replace any prior Beneficiary Designation previously received unless an irrevocable Beneficiary Designation was previously filed with the is the best option to choose?

4 It depends on your objectives. We strongly recommend that you consult with your financial representative and tax advisor to determine which Death Benefit Distribution Option would be most appropriate for meeting your and/or your Beneficiary s(ies ) Designation with a Preselected Death Benefit ElectionNonqualified and IRA Annuity Contracts ONLYHome Office Lansing, for completing the Beneficiary Designation with a Preselected Death Benefit 1: Contract InformationComplete all sections regarding contract 2: Election RequestIndicate if the request is to add, change or cancel a Beneficiary Designation with a Preselected Death benefit 3: Beneficiary DesignationComplete all sections for your designated Beneficiary (ies).

5 Please note, completing this election form will replace any prior revocable Beneficiary election. If there is more than one Beneficiary , please indicate whether they are a Primaryor aContingentbeneficiary. Please use additional forms if you have more than two 3A: Beneficiary Restriction OptionsDetermine the level of restrictions you wish to elect on the payout your Beneficiary (ies) will receive. If there is more than onebeneficiary named, you must select a restriction level for each Beneficiary . No Restriction:The Beneficiary may choose how the Death benefit will be paid.

6 Full Restriction:The total Death benefit payable to this Beneficiary should (or will) be applied to the Death BenefitDistribution Option(s) 3B: Death Benefit Distribution Options Complete this section to select the Death Benefit Distribution Option and any restriction on the timing and amounts of the payments. We strongly recommend you consult with your financial representative and tax advisor to determine which DeathBenefit Distribution Option would be most appropriate for meeting your Beneficiary s(ies ) needs.

7 Lump-Sum Distribution:The Contract Owner(s) selects a certain percentage of the Death benefit to be paid in a lump-sumto their designated Beneficiary (ies). The remainder will be applied to the Death Benefit Distribution Option elected by theContract Owner(s). Life Only Income: Option not available for qualified will be made to the Beneficiary as long as heor she is living and will cease upon his or her Death . Life Income with a Period Certain: Option not available for qualified annuities. A period of five (5) through 30 years isavailable.

8 However, the period certain may not exceed the Beneficiary s life expectancy. Payments will be made to the bene-ficiary as long as he or she is living. If the Beneficiary were to die prior to receiving the period certain payments, theirdesignated successor Beneficiary (ies) may continue any such unpaid payments, or take it in a single lump-sum.* Income for a Specified Period or ISP :A period of five (5) through 60 years is available. The specified period, however,may not extend beyond the Beneficiary s life expectancy.

9 If the Beneficiary were to die prior to receiving the specified numberof payments, his or her designated successor Beneficiary (ies) may continue any such unpaid payments or take it in a singlelump-sum.* Irrevocable Systematic Withdrawal or ISW : Option not available for qualified annuities. The Beneficiary may choose totake distributions over his or her life expectancy. While the Beneficiary must take the minimum amount each year to satisfyIRS requirements, additional amounts may be taken at any time. If elected, the Beneficiary may name a designated successorbeneficiary(ies).

10 If the Beneficiary dies prior to receiving all payments, their designated successor Beneficiary (ies) must takethe current contract value as a lump-sum : Irrevocable Systematic Withdrawal or ISW may not be available on all contracts. stretch IRA: Option available for IRA annuities Beneficiary may choose to take distributions over his or her life expectancy. While the Beneficiary must take the minimum amount each year to satisfy IRS requirements, additional amountsmay be taken at any time. If elected, the Beneficiary may name a designated successor Beneficiary (ies).