Service request forms*

Select the prefix for your variable annuity contract from the list below. Print the form, complete it and return it to the address shown.

• B6 or C6
• 1VA or 2VA
• 1VAA or 2VAA
• 1VAC or 1VAL
• 2VAC or 2VAL

* These forms are portable document format (PDF) files. If your browser is not yet capable of reading PDF files, you can download the free Adobe^® Acrobat Reader™ software at the following link: http://www.adobe.com/prodindex/acrobat/readstep.html.

Instructions for installation are also found at that location.

When you have completed and signed the form, please return it to the address indicated. You may also request these forms be mailed to you by calling our toll-free number, 1-800-487-6669 and speaking to a customer service representative.