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Click ‘Get Form’ to open the nationwide agent of record change form in the editor.
In Section A, select the type of account change that applies by checking the appropriate box. Enter your Policy/Contract number and Plan/Case number or name as specified.
Proceed to Section B, where you will provide information for up to four agents. Fill in each agent's name, Social Security Number, Broker Dealer Name, and Split percentage. Remember, the primary agent will receive all contract confirmations.
If applicable, navigate to Section C for Exchange Authorization. Choose whether to grant fund-to-fund exchange authorization by selecting the appropriate option.
In Section D, indicate your preference regarding Investment Advisor (IA) Information if it pertains to variable annuities or marketFLEX VUL.
Finally, complete Section E by providing signatures and contact information for all required parties based on the type of transfer.

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