Election Form for SecureFoundation Group Fixed Deferred Annuity Certificate

Contract Categories: Business Finance › Subscription Agreements
Summary

This form allows an individual to elect to purchase a Group Fixed Deferred Annuity Certificate from SecureFoundation. By completing and signing the form, the individual acknowledges receipt of the prospectus and agrees to the terms of the annuity certificate. The form requires personal information such as name, address, date of birth, and social security number. The agreement becomes effective upon the individual's signature and date.

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EX-4.3 7 electionform43.htm ELECTION FORM electionform43.htm





SecureFoundationSM
GROUP [FIXED] DEFERRED ANNUITY CERTIFICATE
Election Form


 
OWNER INFORMATION
 
Last Name
 
 
First Name and MI
 
Street Address
 
 
City, State, Zip
 
Home Phone
 
 
Gender
 
Date of Birth
 
 
Social Security Number
 
 


 
 
By signing below, I acknowledge that I have received a copy of the prospectus for the Group [Fixed] Deferred Annuity Certificate and elect to purchase this Certificate.



 



DATE________________________SIGNATURE OF ELECTOR _______________________________________