@properties Contribution Authorization Form
Nationwide Financial – Jackson National – INVESCO
Account Number
*
Market
*
SEP
IRA
NQ
SIMPLE
Uni(k)
Name
*
First
Last
Agent ID
*
Address
*
Street Address
Address Line 2
City
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Alaska
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District of Columbia
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U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
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Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Email
*
Date of Birth
*
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Social Security Number
*
Please Indicate
*
New Enrollment
Change Percentage
Stop Contribution
Authorize Deduction
*
I authorize @ Properties to deduct the following percentage from each commission check earned for contribution to my retirement account:
Percentage (Enter 0 to 100)
*
Please enter a number from
0
to
100
.
Disclaimer
I understand that the total amount I contribute to the retirement account may not exceed IRS Guideline limits.
I understand a withdrawal charge will be assessed by the carrier if more than 10% is withdrawn from the account per contract year.
I have received a copy of the prospectus.
I understand that in order to enroll, make a change in my percent of contribution or stop my participation all together, I must complete my request in writing via the Contribution Authorization Form.
I understand this deduction will be applied to all of my commission payments.
I understand enrollments, changes or stops may take 30 days to process from the date the written request is received by @properties. I further understand that contributions will be initiated or ceased on the earliest funding date following the 30-day processing period.
I understand that deposits to my account will be made on a weekly basis, following closing and payment of commissions.
I understand I may make future contribution changes and/or may stop contributions and they will be effective according to the above schedule.
I understand that my contribution percentage will remain the same if a deal closes and is changed after it closes, despite a downward or upward earnings adjustment.
I understand that this is already a tax-deferred product and want the additional benefits that are associated with a variable annuity.
I understand that the products offered are offered solely by independent third-party providers.
I understand that participation in this program is entirely voluntary on my part.
Digital Signature
*
First
Last
Date
*
Comments
This field is for validation purposes and should be left unchanged.
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