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Click ‘Get Form’ to open the Account Change Request Form in the editor.
Begin by filling out the 'New Primary Producer Information' section. Enter your name, SSN, and Broker Dealer/Firm Name. Ensure that you provide a whole number for the Split%.
If applicable, add information for any 'Additional Producers' by completing their names, SSNs, and Broker Dealer/Firm Names in the designated fields.
In the 'Account Change Type' section, check the appropriate box for your request type and provide any necessary details as instructed.
Complete the 'Owner Information' section with your name and SSN. If there is a joint owner, include their information as well.
Review and complete sections regarding Exchange Authorization and Third Party Manager/Investment Advisor Information if they apply to your situation.
Sign and date where indicated in the 'Signature(s)' section. Ensure all required signatures are obtained before submission.
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Check this box if you did not have income from any other source. Name of Source. Address. Nationwide Life Insurance. PO Box182021. Columbus, OH 43218-2021.Read more
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