Automatic Withdrawal Service Election Form - Lincoln National Life Insurance Company

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The Lincoln National Life Insurance Company
Lincoln Life & Annuity Company of New York
Servicing Office - PO Box 2348, Fort Wayne IN 46801-2348
Fax Number (260) 455-9427
Overnight Address: Lincoln Financial Group, Financial - IA
1300 S Clinton St., Fort Wayne IN 46802-3506
AUTOMATIC WITHDRAWAL SERVICE ELECTION
CONTRACT INFORMATION
Contract Number ____________________________________________________________________________________________
Contract Owner’s Name _______________________________________________________________________________________
h The Lincoln National Life Insurance Company
h Lincoln Life & Annuity Company of New York
Issuing Company
h Other ___________________________________________________________________________________
XXX-XX-
Social Security Number
_____________________________
Date of Birth ___________________________________
(Last 4 digits)
Telephone Number: Daytime ____________________________________
Evening ______________________________________
IMPORTANT INFORMATION
Please review the following statements before electing this service.
Surrender charges may apply if the withdrawal amount is greater than the free amount as stated in the contract or prospectus
.
(if applicable)
Amounts are withdrawn on a pro rata basis from each subaccount, unless otherwise specified. This program can be set up to have
the withdrawal taken from one specific variable fund
. The option of fund-specific withdrawals is not available with living
(if applicable)
benefit riders.
Withdrawals in excess of the guaranteed withdrawal amount, called “excess withdrawals”, will result in a permanent reduction in future
guaranteed withdrawal amounts. If you would like to make an excess withdrawal and are uncertain how an excess withdrawal will reduce your
future guaranteed withdrawal amounts, then you may contact us prior to requesting the withdrawal to obtain a personalized, transaction-
specific calculation showing the effect of the excess withdrawal.
Withdrawal minimum: $50 per distribution/$300 annually. Contract Minimum: $10,000.
AUTOMATIC WITHDRAWAL OPTIONS
If electing an automatic withdrawal option based on a living benefit rider:
Beginning a new automatic withdrawal option - the amount allowed through your rider will be withdrawn during the current benefit year.
Changing from an existing automatic withdrawal option - the new option will begin at your next benefit anniversary.
Withdrawals will automatically increase if additional deposits are made or if the account value step-up/reset results in a higher amount
guaranteed with your rider. Additional withdrawals could result in a reduced allowable withdrawal amount.
Automatic withdrawals will stop for the remainder of a benefit year if the withdrawal amount allowed through your rider has been
exceeded due to other withdrawals, if you have selected withdrawal option A, B, or C.
Withdrawals prior to meeting minimum age requirements (including Joint Life, if applicable) may substantially deplete or eliminate
the amount guaranteed through your rider and may result in termination of the rider, contract, or availability of lifetime withdrawals.
Please refer to your prospectus, speak with your advisor, or contact Customer Service.
h A. Withdraw _____% with Lincoln SmartSecurity
®
Advantage
(1%-5% for SmartSecurity 1-year or 1%-7% for SmartSecurity 5-year)
h B. Withdraw _____% with Lincoln Lifetime Income
SM
Advantage option
(1%-5%. Not available prior to age 59 1/2 for Single Life or both
Joint Lives attaining age 65.)
h C. Withdraw the Guaranteed Annual Income amount through Lincoln Lifetime Income Advantage 2.0
(Not available if the Single
Covered Life or either Joint Covered Life is under age 55)
_______
I authorize the excess withdrawal requested below. The amount requested exceeds
(Initial Here if taking an excess withdrawal)
the amount guaranteed through a living benefit rider, and I am aware of the potential impact to rider guarantees. If initials are not
included, the amount guaranteed through the rider will be the maximum amount that will be processed.
h D. Withdraw $ __________________ per payment frequency.
h E. Withdraw free amount based on contractual free withdrawal provision.
h F. Withdraw_______% of the contract value or purchase payments
.
(up to 10% or 15% based on contractual free withdrawal provision)
h G. Withdraw earnings or interest above this baseline: $ __________________
(You may need to adjust this baseline due to purchase payments or
withdrawals. If the contract value is below the baseline, no automatic withdrawal will occur.)
Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates.
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