Submit with Application Thank you for choosing to purchase the NWL® Impact Annuity. If you have any questions after you receive your annuity Policy, please contact your agent or call National Western’s Client Services Department at 1-800-922-9422. We want to be sure that you read all 14 pages of this disclosure brochure and are aware of the benefits and features explained within it, including but not limited to the following: • This is a deferred annuity, and it is a long-term savings vehicle.
• Unless you exercise an available option to avoid Withdrawal Charges, you will incur a Withdrawal Charge and you will incur a reduction in your Bonus Value. Withdrawal Charges may be deducted from your Account Value. • Your agent receives compensation for the sale of this annuity Policy. • The Annuity Date is 10 years after the Policy Date and may only be changed to a date no later than the Policy anniversary on which the annuitant attains age 99. • The Interest Credit Option B fixed interest rate will likely be higher in the first Policy Year than in subsequent Policy Years. • The Participation Rates will likely be higher in the first Policy Year than in subsequent Policy Years and may be as low as 20%, and Asset Fee Rates will likely be lower in the first Policy Year than in subsequent Policy Years and may be as high as 6%. • You can allocate 100% to Option A, B, U or in any combination among Option A, B, U in whole numbers whose sum is 100%.
• This annuity has a “free look” period, during which you can surrender the annuity Policy after receiving it without incurring Withdrawal Charges (described more fully in your annuity Policy). • Any results shown, other than guaranteed minimum values, are not guarantees, promises, or warranties. • For any Policy issued as a tax-qualified plan, you may have to make withdrawals to meet minimum distribution requirements. • If applied for, the Annual Charge for a Withdrawal Benefit Rider may be deducted from your Account Value. • The Bonus Value in this policy is subject to the Bonus Vesting Schedule. Your bonus is vested 5% at the end of year 1, 10% at the end of year 2, 15% at the end of year 3, 20% at the end of year 4, 30% at the end of year 5, 40% at the end of year 6, 50% at the end of year 7, 60% at the end of year 8, 70% at the end of year 9, and 100% at the end of year 10.
State your allocation percentage(s) here Note that if only one allocation percentage is marked, NWL will allocate 100% to that Option.
Monthly Average Option A
Fixed Interest Rate Option B
Low Volatility Annual Point-to-Point Option U
%
%
%
Option A and U may not be available on renewal.
By signing below, I certify that I have received a copy of this disclosure brochure and that I have reviewed it with my agent. I further certify that I fully understand the disclosure brochure and the specific points outlined above, which have been explained to me in complete detail, and I will not contest the sufficiency of my signature below as a valid and enforceable acknowledgment of my understanding of the information contained in this disclosure brochure. I understand that the disclosure brochure is not a part of the annuity Policy and does not modify it in any way, and I further understand that the annuity Policy itself contains all terms, benefits, guarantees, limitations, restrictions, and exclusions.
Applicant’s Name (Printed)
Applicant’s Signature
Date
Joint Applicant’s Name (Printed)
Joint Applicant’s Signature
Date
I certify that I reviewed this disclosure brochure with the applicant.
Agent’s Name (Printed)
Agent’s Signature
Date
Agent No.
Agent Lic. No.
DM-1398-SIG-Rev.8.22
NATIONALWESTERNLIFE.COM
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