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Name

 

Gender

 

Date of Birth

 

Spousal Date of Birth

 

Spousal Gender

 

Participant State of Residence

 

Plan Sponsor State Domicile

 

Type of Annuity

Life Only10 Year Fixed PeriodLife, 10 Year Fixed PeriodJoint And Survivor 50%Joint And Survivor 50%, 10 Year Fixed15 Year Fixed PeriodLife, 15 Year Fixed PeriodJoint And Survivor 75%Joint And Survivor 75%, 10 Year Fixed20 Year Fixed PeriodLife, 20 Year Fixed PeriodJoint And Survivor 100%Joint And Survivor 100%, 10 Yr Fixed

 

Premium Ammount - Defined Contribution

 

Benefit Ammount - Defined Benefit

 

Benefit Payment Frequency

 

Source of Funds

 

Type of Plan

 

Email Address

 

Telephone

 

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