850 East Anderson Lane Austin, Texas

Transcription

1 APPLICATION FOR ANNUITY 850 East Anderson Lane Austin, Texas ANNUITANT: Name Sex DOB Age Address Address City State Zip Drivers License No. and State SSN Telephone No. CO-ANNUITANT: Name Sex DOB Age Address Address City State Zip Drivers License No. and State SSN Telephone No. OWNER: This section must be left blank on IRA and SEP plans. Full Name (if other than annuitant) Sex DOB Age Address Address City State Zip Drivers License No. and State SSN/TIN Telephone No. Joint Owner Sex DOB Age Address Address City State Zip Drivers License No. and State SSN/TIN Telephone No. Contingent Owner (if other than annuitant) Sex DOB Age Address Address City State Zip Drivers License No. and State SSN/TIN Telephone No. BENEFICIARY: Attach additional beneficiary or contingent beneficiary information on separate page. Percent must add up to 100%. Primary Beneficiary SSN/TIN DOB Address Address Telephone No. Drivers License No. and State Relationship to Annuitant Percent of Benefit Primary Beneficiary SSN/TIN DOB Address Address Telephone No. Drivers License No. and State Relationship to Annuitant Percent of Benefit PLAN: Plan Name Tax Status: IRA SEP-IRA Roth-IRA Non-Qualified Other* (Must also mark one box below) 401(K) Profit Sharing Defined Benefit Keogh/HR10 Money Purchase Plan *Satisfaction of applicable tax qualifications and all other legal requirements regarding the tax qualified status of the plan is the responsibility of the plan sponsor and/or administrator, not National Western. National Western will issue a non-qualified annuity under this option. OTHER COVERAGE AND REPLACEMENT: 1. Does the applicant have any existing life insurance or annuity contracts?... Yes No 2. If yes, is this annuity intended to replace or change any existing life insurance or annuity contracts?... Yes No (If yes, please submit appropriate state replacement forms.) PREMIUMS: Submitted with application $ If IRA, premium submitted applies to tax year Amount to be billed $ Expected first year premium $ Anticipated amount on policy exchanges or transfers $ (If any, attach Transfer Form No. SA-8600, the policy/document that is to be exchanged.) Mode: Single Premium Annual Semi-annual Monthly Other Billing Type: Bank Draft Direct Bill List Bill Government Allotment Other Special Billing Instructions: Billing Name Address City State Zip FL-14(Rev.09/16) Page 1 of 2

2 SPECIAL REQUESTS: I have read the statements above and to the best of my knowledge and belief they are true and complete. Any statement made by either the agent of this application or by any other person shall not be binding on the Company unless such statement is reduced to writing by the Company and made a part of the annuity contract. I have received and read a copy of the annuity information brochure and understand the features of the plan of insurance applied for. I am not currently taking, and I am not under the influence of, any medications or drugs that would affect my ability to fully understand and accurately complete this application. ANY PERSON WHO KNOWINGLY AND WITH INTENT TO INJURE, DEFRAUD, OR DECEIVE ANY INSURER FILES A STATEMENT OF CLAIM OR AN APPLICATION CONTAINING ANY FALSE, INCOMPLETE, OR MISLEADING INFORMATION IS GUILTY OF A FELONY OF THE THIRD DEGREE. Signed in (City) (State) on (date) Owner Signature (Include title if signing on behalf of a minor,trust, Corp, or any other entity) Annuitant Signature Agent Signature Joint Owner Signature Co-Annuitant Signature AGENT S SECTION: 1. Does the applicant have any existing life insurance or annuity contracts?... Yes No 2. If yes, is this annuity intended to replace any existing life insurance or annuity contracts?... Yes No (If yes, please submit appropriate state replacement forms.) USA PATRIOT Act Notice 1. The USA PATRIOT Act requires that we establish an Anti-Money Laundering (AML) Compliance Program, and as part of our Program, National Western Life Insurance Company requires that its agents/brokers/consultants verify the identity of the proposed owner(s) of our contracts and collect documents and/or information sufficient to provide such verification. Please refer to your company-specific AML training materials for more detailed information. Owner/Trustee Verification - In order to satisfy such obligations, we require that you review and verify a current driver s license or government-issued photo ID for the proposed Owner/Trustee associated with the contract. 2. Do you certify that you personally met with the proposed Owner/Trustee and reviewed his or her identification document (driver s license or government-issued photo ID) and that to the best of your knowledge, it accurately reflects the identity of the proposed Owner/Trustee?... Yes No If no, please explain Agent Signature Agent Number Agent Name (printed) Agent Phone Florida License ID Number: Commission Splits: Agent Number Agent Name Commission Split % % % % ***ALL CHECKS MUST BE PAYABLE TO NATIONAL WESTERN LIFE INSURANCE COMPANY *** NATIONAL WESTERN LIFE INSURANCE COMPANY 850 EAST ANDERSON LANE AUSTIN, TEXAS Print Annuitant s Name Date Page 2 of FL-14(Rev.09/16)

3 ANNUITY WITHDRAWAL BENEFIT RIDER APPLICATION SUPPLEMENT To apply for The Income Outlook or Income Outlook Plus 5 This application supplement must be completed and submitted with the annuity application to add one of the Withdrawal Benefit Riders to your annuity. A Withdrawal Benefit Rider will not be added to your annuity after the annuity application has been processed. There is a charge for each rider, which is assessed annually until the rider is terminated. The rider charge for the Income Outlook (form , and state variations) is based upon a percentage of the Account Value of the annuity. The rider charge for the Income Outlook Plus 5 (form , and state variations) is based upon a percentage of either, the Accumulation Period Withdrawal Payment Base during the Accumulation Period, or the Withdrawal Payment Base during the Withdrawal Period. Annuitant Name Date of Birth (Name must match annuity application) Annuitant Signature Joint Annuitant (If electing joint rider payout) Date of Birth Joint Annuitant Signature Owner Name Owner Signature (Name must match annuity application) Joint Owner Joint Owner Signature (Name must match annuity application, if applicable) Dated at, this day of 20 City State Month Year Agent Printed Name Agent Number Agent Signature as Witness Florida License Number 01- S026FL- 15 NATIONAL WESTERN LIFE INSURANCE COMPANY 850 EAST ANDERSON LANE AUSTIN, TEXAS

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5 INCOME OUTLOOK NWL s Withdrawal Benefit Rider A Sure WIN to Provide Security For Your Withdrawal Income Needs! National Western Life Insurance Company 850 East Anderson Lane Austin, Texas Page 12 Page 12 DM-1049.Rev.4.16

6 INCOME OUTLOOK NWL s Withdrawal Benefit Rider Enjoy the benefits of guaranteed lifetime retirement income with enhanced accumulations and control of your annuity! National Western Life requires that the Agent review this entire brochure with you. NWL s Income Outlook provides: Great growth potential for your lifetime Withdrawal Payments... Control of when your Withdrawal Payments begin... Guaranteed Withdrawal Percentages that increase every year... Access to your money for Additional Withdrawals remains... Guaranteed Withdrawal Payments for life anytime after the age of 60! Adding Income Outlook to your National Western Life equity indexed annuity at purchase will give you all of these benefits. This withdrawal benefit rider works with all of your annuity s traditional benefits and enhances the benefits with guaranteed Withdrawal Payments you cannot outlive. INCOME OUTLOOK HIGHLIGHTS Income Outlook guarantees during the Accumulation Period: 3% interest on the Accumulation Period Withdrawal Payment Base until lifetime Withdrawal Payments begin The Guaranteed Withdrawal Percentages increase every year until age 90 or until the lifetime Withdrawal Payments begin Access to the annuity s Account Value remains The option to Restart the ten year Accumulation Period at the end of the fifth Policy Year Income Outlook guarantees during the Withdrawal Period: Withdrawal Payments that can be paid for life The ability to stop and start Withdrawal Payments No withdrawal charges on Withdrawal Payments taken under this rider The Withdrawal Payment Base to Step-Up to the annuity s Account Value*, if larger, when the Withdrawal Period begins and each Policy Anniversary thereafter The Maximum Guaranteed Annual Withdrawal Payment increases each time there is a Step-Up in the Withdrawal Payment Base Access to the annuity s Account Value remains Required Minimum Distribution friendly *If the base annuity policy has a premium bonus that is not included in the Account Value, then for purposes of Restart, Step-Up, and Withdrawal Payment Base, the Account Value will be increased by any applicable base annuity Vested Bonus Value. Page 2

7 INCOME OUTLOOK DETAILS Income Outlook is available to add as a rider to your National Western Life equity indexed annuity only at the time of purchase. The Withdrawal Payment is the amount you choose to receive each year. The Maximum Guaranteed Annual Withdrawal Payment is guaranteed to be paid for your lifetime if no Additional Withdrawals are taken. Your age must be at least 60 before Withdrawal Payments may begin. You may begin taking Withdrawal Payments as early as the first Policy Anniversary or any Policy Anniversary you choose after that. The Withdrawal Payments taken under this rider are deducted from the annuity s Account Value and will not incur any withdrawal charges. Cancellation You may cancel this rider at anytime. The rider will terminate when the annuity terminates for any reason or when the Maximum Guaranteed Annual Withdrawal Payment is less than $100. CONCLUSION Income Outlook from National Western Life provides the security of a guaranteed income stream you can not outlive in retirement. This rider also offers the opportunity for larger income benefits when indexed interest credits increase your annuity s Account Value. It also gives you control of your annuity as your needs change and access to your money if needed. About the Company National Western Life Insurance Company is a Colorado corporation with executive offices in Austin, Texas. The Company offers a full line of life insurance and annuity products in 49 states and the District of Columbia, and accepts applications from residents of several foreign countries. Visit our website com for all current financial information. Since its start in 1956, National Western has emphasized financial strength for the protection of its policyholders. As a legal reserve insurance company, National Western must set aside a portion of its assets equal to reserves required by law. Annually, a financial statement is filed with each state s insurance department. These departments have authority to verify that the appropriate reserves are maintained. Page 10 There is an Annual Rider Charge for this benefit on each Policy Anniversary, beginning with the first. The Annual Rider Charge Rate is determined on the Policy Date and is shown on page 1 of the rider. This rate is guaranteed not to change while this rider is in force unless Restart (as described below) is elected and will never exceed the maximum rate of 1.00%. The Annual Rider Charge will never exceed, the smaller of: 1) the Annual Rider Charge Rate times the Account Value on the Policy Anniversary, prior to any interest credits; or 2) the Interest Credits on the Account Value for the Policy Year. In other words, the Annual Rider Charge will not reduce the annuity s Account Value by more than the interest credits for that Policy Year. The rider has two periods, the Accumulation Period and the Withdrawal Period. Each period is described as follows. Page 3

8 During the Accumulation Period The Accumulation Period Withdrawal Payment Base has a 3% interest rate that is guaranteed each year during the Accumulation Period. The Accumulation Period Withdrawal Payment Base initially equals the premium paid, plus any applicable premium bonus. Additional premiums paid and premium bonuses, if applicable, will be added to the Accumulation Period Withdrawal Payment Base when they are received. Withdrawals made from the Account Value will reduce the Accumulation Period Withdrawal Payment Base. As the Payment Base grows, so do your guaranteed Withdrawal Payments for life. Restart During the Accumulation Period, you may Restart the 3% guaranteed interest rate anytime after the fifth Policy Year. At the time you Restart the Accumulation Period, the following will happen: The 3% guaranteed interest rate on the Accumulation Period Withdrawal Payment Base will be guaranteed from Restart; The Accumulation Period Withdrawal Payment Base will be increased to the annuity s Account Value*, if larger; and The Annual Rider Charge Rate may change, but will not be higher than the maximum guaranteed charge of 1%. You must wait five years after each Restart before beginning a new Accumulation Period. *If the base annuity policy has a premium bonus that is not included in the Account Value, then for purposes of Restart, Step-Up, and Withdrawal Payment Base, the Account Value will be increased by any applicable base annuity Vested Bonus Value. Withdrawals Withdrawals may be made at anytime as provided by the annuity. Withdrawals from your annuity will reduce the Accumulation Period Withdrawal Payment Base by the same percentage reduction made to the annuity s Account Value. Page 4

9 Example: A $20,000 withdrawal is made. The Account Value is $250,000 before the withdrawal. After the withdrawal the Account Value is $230,000, or 92% of the Account Value before the withdrawal. The Accumulation Period Withdrawal Payment Base is $240,000 before the withdrawal. It is multiplied by 92% and equals $220,800 after the Withdrawal. Account Value $250,000-20,000 $230, , ,000 = 92% $240,000 x.92 $220,800 Accumulation Period Withdrawal Payment Base The Accumulation Period ends when you begin taking Withdrawal Payments. At that time, the Withdrawal Period begins. During the Withdrawal Period The Withdrawal Payment amount you choose to receive is guaranteed to be paid for your lifetime if it does not exceed the Maximum Guaranteed Annual Withdrawal Payment. The Maximum Guaranteed Annual Withdrawal Payment will remain level unless there is a Step-Up in the Withdrawal Payment Base, or you take an Additional Withdrawal. You may receive your Withdrawal Payment annually, semi-annually, quarterly, or monthly. Each payment must be at least $100. Any election to start or stop withdrawal payments must be received at National Western Life Insurance Company at least 20 days prior to the Policy Anniversary. When the Withdrawal Period begins: The Guaranteed Withdrawal Percentage is determined; The Withdrawal Payment Base is increased to the annuity s Account Value* if it is larger; The Maximum Guaranteed Annual Withdrawal Payment is calculated; Any outstanding loan must be repaid; No more loans or Systematic Withdrawals of Interest from the Account Value of the policy may be taken; and Any applicable penalty-free withdrawal amount that is available each Policy Year under the base annuity policy will be reduced by the Withdrawal Payment. *If the base annuity policy has a premium bonus that is not included in the Account Value, then for purposes of Restart, Step-Up, and Withdrawal Payment Base, the Account Value will be increased by any applicable base annuity Vested Bonus Value. The Guaranteed Withdrawal Percentage is based on your age at the beginning of the Withdrawal Period. This percentage will not change during the Withdrawal Period. The Maximum Guaranteed Annual Withdrawal Payment equals the Withdrawal Payment Base multiplied by the Guaranteed Withdrawal Percentage. Example: Five years ago, you purchased an annuity with Income Outlook with $100,000 and have now decided to begin Withdrawal Payments. The Withdrawal Payment Base is now $115,927 after five years of 3% interest and your Guaranteed Withdrawal Percentage is 6.8%. At this time, your Maximum Guaranteed Annual Withdrawal Payment is $7,883 and your annuity s Account Value is $131,317. Therefore, the Withdrawal Payment Base is increased to the Account Value and your Maximum Guaranteed Annual Withdrawal Payment is $8,930. Page 5

10 Step-up On each Policy Anniversary during the Withdrawal Period, the Withdrawal Payment Base will be compared to the annuity s Account Value*. If the Account Value* is larger than the Withdrawal Payment Base, the Withdrawal Payment Base will Step-Up to the Account Value*. Following the Step-Up, the Maximum Guaranteed Annual Withdrawal Payment is recalculated and increased, based on this higher Withdrawal Payment Base. These payments are guaranteed for your lifetime. Example: At the end of two years of Withdrawal Payments, your annuity s Account Value has grown to $132,725. Your Withdrawal Payment Base of $131,317 will Step-Up to $132,725. The Maximum Guaranteed Annual Withdrawal Payment will be increased to $9,025, which equals the Withdrawal Payment Base of $132,725 multiplied by the Guaranteed Withdrawal Percentage of 6.8%. How Is The Maximum Guaranteed Annual Withdrawal Payment (MGAWP) Calculated? Policy Annuitants Years Age Scenario 1 Scenario 2 Scenario 3 Age 65-1 Year Accumulation Age 65-5 Year Accumulation Age Year Accumulation Withdrawal Payment Base Guaranteed Withdrawal Percentage , , % , % MGAWP Withdrawal Payment Base Guaranteed Withdrawal Percentage MGAWP Withdrawal Payment Base 100, ,000 5, , ,000 5, , ,090 Guaranteed Withdrawal Percentage MGAWP , % 5, , ,273 *If the base annuity policy has a premium bonus that is not included in the Account Value, then for purposes of Restart, Step-Up, and Withdrawal , % 5, , ,551 Payment Base, the Account Value will be increased by any applicable base annuity Vested Bonus Value , % 5, , % 6, , , % 5, , % 6, , , % 5, , % 6, , , % 5, , % 6, , , % 5, , % 6, , , % 5, , % 6, , % 8, , % 5, , % 6, , % 8, , % 5, , % 6, , % 8, , % 5, , % 6, , % 8, , % 5, , % 6, , % 8, , % 5, , % 6, , % 8,735 Additional Withdrawals An Additional Withdrawal is any withdrawal that is not a Withdrawal Payment and may be made at anytime during the Withdrawal Period. Additional Withdrawals reduce the Withdrawal Payment Base and Withdrawal Payments using the pro-rata adjustment factor. The pro-rata adjustment factor is based on the change in Account Value due to the Additional Withdrawal. The Maximum Guaranteed Annual Withdrawal Payment will change to equal the Guaranteed Withdrawal Percentage multiplied by the Withdrawal Payment Base after the Additional Withdrawal. The new Maximum Guaranteed Annual Withdrawal Payment will become effective on the Policy Anniversary following the Additional Withdrawal. Required Minimum Distributions (RMDs) If the RMD payment is greater than the Maximum Guaranteed Annual Withdrawal Payment, the additional amount withdrawn to meet the RMD payment will not be considered an Additional Withdrawal. Page 6 This is a hypothetical example only. This example does not demonstrate an actual crediting scenario and is not a projection of the future results. Page 7

11 Step-up On each Policy Anniversary during the Withdrawal Period, the Withdrawal Payment Base will be compared to the annuity s Account Value*. If the Account Value* is larger than the Withdrawal Payment Base, the Withdrawal Payment Base will Step-Up to the Account Value*. Following the Step-Up, the Maximum Guaranteed Annual Withdrawal Payment is recalculated and increased, based on this higher Withdrawal Payment Base. These payments are guaranteed for your lifetime. Example: At the end of two years of Withdrawal Payments, your annuity s Account Value has grown to $132,725. Your Withdrawal Payment Base of $131,317 will Step-Up to $132,725. The Maximum Guaranteed Annual Withdrawal Payment will be increased to $9,025, which equals the Withdrawal Payment Base of $132,725 multiplied by the Guaranteed Withdrawal Percentage of 6.8%. How Is The Maximum Guaranteed Annual Withdrawal Payment (MGAWP) Calculated? Policy Annuitants Years Age Scenario 1 Scenario 2 Scenario 3 Age 65-1 Year Accumulation Age 65-5 Year Accumulation Age Year Accumulation Withdrawal Payment Base Guaranteed Withdrawal Percentage , , % , % MGAWP Withdrawal Payment Base Guaranteed Withdrawal Percentage MGAWP Withdrawal Payment Base 100, ,000 5, , ,000 5, , ,090 Guaranteed Withdrawal Percentage MGAWP , % 5, , ,273 *If the base annuity policy has a premium bonus that is not included in the Account Value, then for purposes of Restart, Step-Up, and Withdrawal , % 5, , ,551 Payment Base, the Account Value will be increased by any applicable base annuity Vested Bonus Value , % 5, , % 6, , , % 5, , % 6, , , % 5, , % 6, , , % 5, , % 6, , , % 5, , % 6, , , % 5, , % 6, , % 8, , % 5, , % 6, , % 8, , % 5, , % 6, , % 8, , % 5, , % 6, , % 8, , % 5, , % 6, , % 8, , % 5, , % 6, , % 8,735 Additional Withdrawals An Additional Withdrawal is any withdrawal that is not a Withdrawal Payment and may be made at anytime during the Withdrawal Period. Additional Withdrawals reduce the Withdrawal Payment Base and Withdrawal Payments using the pro-rata adjustment factor. The pro-rata adjustment factor is based on the change in Account Value due to the Additional Withdrawal. The Maximum Guaranteed Annual Withdrawal Payment will change to equal the Guaranteed Withdrawal Percentage multiplied by the Withdrawal Payment Base after the Additional Withdrawal. The new Maximum Guaranteed Annual Withdrawal Payment will become effective on the Policy Anniversary following the Additional Withdrawal. Required Minimum Distributions (RMDs) If the RMD payment is greater than the Maximum Guaranteed Annual Withdrawal Payment, the additional amount withdrawn to meet the RMD payment will not be considered an Additional Withdrawal. Page 6 This is a hypothetical example only. This example does not demonstrate an actual crediting scenario and is not a projection of the future results. Page 7

12 ADDITIONAL DETAILS Issue Ages Income Outlook may be added to the annuity at purchase, regardless of age. Premium Allocation Premiums may be allocated to any Interest Credit Options and in any combination that is allowed by the annuity. All premiums paid during the Accumulation Period are guaranteed to be included in the Accumulation Period Withdrawal Payment Base and will receive the 3% guaranteed interest rate. Annuitants The annuitant and joint annuitant, if any, cannot be changed after the annuity is issued. Two annuitants are allowed on this rider only. The Withdrawal Payment is guaranteed to be paid until the death of the last surviving annuitant. The Guaranteed Withdrawal Percentage is based on the age of the younger annuitant. Guaranteed Withdrawal Percentages The Guaranteed Withdrawal Percentage is based on your age on the Policy Anniversary that you begin Withdrawal Payments. Age Percentage Age Percentage Age Percentage Age Percentage % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % The table below has the Guaranteed Withdrawal Percentages when there are joint annuitants. The percentage is based on the age of the younger annuitant on the Policy Anniversary that you begin Withdrawal Payments. Age Percentage Age Percentage Age Percentage Age Percentage % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % Page 8

13 $100,000 Premium Maximum Guaranteed Annual Withdrawal Payments Issue Age Number of Full Years of Accumulation before Withdrawal Payments Begin $5,253 $5,517 $5,791 $6,078 $6,376 $6,687 $7,010 $7,347 $7,698 $8, $5,356 $5,623 $5,901 $6,190 $6,492 $6,806 $7,133 $7,474 $7,829 $8, $5,459 $5,729 $6,010 $6,303 $6,608 $6,926 $7,256 $7,601 $7,959 $8, $5,562 $5,835 $6,119 $6,415 $6,724 $7,045 $7,379 $7,727 $8,090 $8, $5,665 $5,941 $6,229 $6,528 $6,840 $7,164 $7,502 $7,854 $8,220 $8, $5,768 $6,047 $6,338 $6,641 $6,956 $7,284 $7,625 $7,981 $8,351 $8, $5,871 $6,153 $6,447 $6,753 $7,072 $7,403 $7,748 $8,107 $8,481 $8, $5,974 $6,259 $6,556 $6,866 $7,187 $7,523 $7,871 $8,234 $8,612 $9, $6,077 $6,365 $6,666 $6,978 $7,303 $7,642 $7,994 $8,361 $8,742 $9, $6,180 $6,471 $6,775 $7,091 $7,419 $7,761 $8,117 $8,487 $8,872 $9, $6,283 $6,578 $6,884 $7,203 $7,535 $7,881 $8,240 $8,614 $9,003 $9, $6,386 $6,684 $6,993 $7,316 $7,651 $8,000 $8,363 $8,741 $9,133 $9, $6,489 $6,790 $7,103 $7,428 $7,767 $8,120 $8,486 $8,867 $9,264 $9, $6,592 $6,896 $7,212 $7,541 $7,883 $8,239 $8,609 $8,994 $9,394 $9, $6,695 $7,002 $7,321 $7,653 $7,999 $8,358 $8,732 $9,121 $9,525 $9, $6,798 $7,108 $7,431 $7,766 $8,115 $8,478 $8,855 $9,247 $9,655 $10, $6,901 $7,214 $7,540 $7,879 $8,231 $8,597 $8,978 $9,374 $9,786 $10, $7,004 $7,320 $7,649 $7,991 $8,347 $8,717 $9,101 $9,501 $9,916 $10, $7,107 $7,426 $7,758 $8,104 $8,463 $8,836 $9,224 $9,627 $10,047 $10, $7,210 $7,532 $7,868 $8,216 $8,579 $8,955 $9,347 $9,754 $10,177 $10, $7,313 $7,638 $7,977 $8,329 $8,695 $9,075 $9,470 $9,881 $10,308 $10, $7,416 $7,745 $8,086 $8,441 $8,810 $9,194 $9,593 $10,007 $10,438 $ $7,519 $7,851 $8,195 $8,554 $8,926 $9,314 $9,716 $10,134 $10,438 $10, $7,622 $7,957 $8,305 $8,666 $9,042 $9,433 $9,839 $10,134 $10,438 $10, $7,725 $8,063 $8,414 $8,779 $9,158 $9,552 $9,839 $10,134 $10,438 $10, $7,828 $8,169 $8,523 $8,892 $9,274 $9,552 $9,839 $10,134 $10,438 $10,751 Page 9

14 INCOME OUTLOOK DETAILS Income Outlook is available to add as a rider to your National Western Life equity indexed annuity only at the time of purchase. The Withdrawal Payment is the amount you choose to receive each year. The Maximum Guaranteed Annual Withdrawal Payment is guaranteed to be paid for your lifetime if no Additional Withdrawals are taken. Your age must be at least 60 before Withdrawal Payments may begin. You may begin taking Withdrawal Payments as early as the first Policy Anniversary or any Policy Anniversary you choose after that. The Withdrawal Payments taken under this rider are deducted from the annuity s Account Value and will not incur any withdrawal charges. Cancellation You may cancel this rider at anytime. The rider will terminate when the annuity terminates for any reason or when the Maximum Guaranteed Annual Withdrawal Payment is less than $100. CONCLUSION Income Outlook from National Western Life provides the security of a guaranteed income stream you can not outlive in retirement. This rider also offers the opportunity for larger income benefits when indexed interest credits increase your annuity s Account Value. It also gives you control of your annuity as your needs change and access to your money if needed. About the Company National Western Life Insurance Company is a Colorado corporation with executive offices in Austin, Texas. The Company offers a full line of life insurance and annuity products in 49 states and the District of Columbia, and accepts applications from residents of several foreign countries. Visit our website com for all current financial information. Since its start in 1956, National Western has emphasized financial strength for the protection of its policyholders. As a legal reserve insurance company, National Western must set aside a portion of its assets equal to reserves required by law. Annually, a financial statement is filed with each state s insurance department. These departments have authority to verify that the appropriate reserves are maintained. Page 10 There is an Annual Rider Charge for this benefit on each Policy Anniversary, beginning with the first. The Annual Rider Charge Rate is determined on the Policy Date and is shown on page 1 of the rider. This rate is guaranteed not to change while this rider is in force unless Restart (as described below) is elected and will never exceed the maximum rate of 1.00%. The Annual Rider Charge will never exceed, the smaller of: 1) the Annual Rider Charge Rate times the Account Value on the Policy Anniversary, prior to any interest credits; or 2) the Interest Credits on the Account Value for the Policy Year. In other words, the Annual Rider Charge will not reduce the annuity s Account Value by more than the interest credits for that Policy Year. The rider has two periods, the Accumulation Period and the Withdrawal Period. Each period is described as follows. Page 3

15 NATIONAL WESTERN LIFE INSURANCE COMPANY Income Outlook - Withdrawal Benefit Rider Thank you for choosing to add Income Outlook to your National Western Life equity indexed annuity. If you have any questions, please contact your agent or call National Western s Customer Service Department at We want to be sure that you read all 12 pages of this brochure and are aware of the benefits and features explained herein. Please initial and sign where indicated with an asterisk (*), acknowledging that you understand the following: This is a withdrawal benefit rider that guarantees lifetime Withdrawal Payments after age 60. For purposes of this brochure, the assumption is that the Annuitant and Owner are the same. If you annuitize your annuity, this rider will terminate. Once the Withdrawal Payments begin, there is no further Accumulation Period available. The benefits of this rider are not obtained if the Withdrawal Payments are never taken. The Account Value of the policy is reduced each year for the Annual Rider Charge when Interest Credits are positive, regardless of whether Withdrawal Payments are taken. If at the end of Accumulation Period you have not yet requested Withdrawal Payments or elected the Restart option, the Annual Rider Charge will continue to be deducted from the Account Value and the Accumulation Period Withdrawal Payment Base will no longer accumulate with interest. Any election to start or stop withdrawal payments must be received at National Western Life Insurance Company at least 20 days prior to the Policy Anniversary. * The above-stated features have been fully explaine Initial to me. I have received a copy of this brochure, and I have reviewed it with my agent. I fully understand the brochure and the specific points outlined above. The brochure is not a part of the rider and does not modify it in any way. The rider itself contains all terms, benefits, guarantees, limitations, restrictions, and exclusions. *Applicant s Signature Date I certify that I reviewed this brochure with the applicant Agent s Signature & Agent No. Date DM-1049-SIG.Rev.4.16 Applicant to Retain DM-1049-SIG.Rev.4.16 NATIONAL WESTERN LIFE INSURANCE COMPANY Income Outlook - Withdrawal Benefit Rider Thank you for choosing to add Income Outlook to your National Western Life equity indexed annuity. If you have any questions, please contact your agent or call National Western s Customer Service Department at We want to be sure that you read all 12 pages of this brochure and are aware of the benefits and features explained herein. Please initial and sign where indicated with an asterisk (*), acknowledging that you understand the following: This is a withdrawal benefit rider that guarantees lifetime Withdrawal Payments after age 60. For purposes of this brochure, the assumption is that the Annuitant and Owner are the same. If you annuitize your annuity, this rider will terminate. Once the Withdrawal Payments begin, there is no further Accumulation Period available. The benefits of this rider are not obtained if the Withdrawal Payments are never taken. The Account Value of the policy is reduced each year for the Annual Rider Charge when Interest Credits are positive, regardless of whether Withdrawal Payments are taken. If at the end of Accumulation Period you have not yet requested Withdrawal Payments or elected the Restart option, the Annual Rider Charge will continue to be deducted from the Account Value and the Accumulation Period Withdrawal Payment Base will no longer accumulate with interest. Any election to start or stop withdrawal payments must be received at National Western Life Insurance Company at least 20 days prior to the Policy Anniversary. * The above-stated features have been fully explained Initial to me. I have received a copy of this brochure, and I have reviewed it with my agent. I fully understand the brochure and the specific points outlined above. The brochure is not a part of the rider and does not modify it in any way. The rider itself contains all terms, benefits, guarantees, limitations, restrictions, and exclusions. *Applicant s Signature Date I certify that I reviewed this brochure with the applicant Agent s Signature & Agent No. Date Submit with Application Page 11 Page 11

16 INCOME OUTLOOK NWL s Withdrawal Benefit Rider A Sure WIN to Provide Security For Your Withdrawal Income Needs! National Western Life Insurance Company 850 East Anderson Lane Austin, Texas Page 12 Page 12 DM-1049.Rev.4.16

17 Protect your hard-earned money! You may choose the advantage of interest accumulation based on a formula linked in part to an index! A Flexible Premium Deferred Equity Indexed Annuity For Long Term Accumulation Consumer Information Summary and Disclosure Brochure Policy Form FL NWL U L T R F U T U R E National Western Life Insurance Company 850 East Anderson Lane Austin, Texas This Consumer Information Summary and Disclosure Brochure is not part of the Policy and does not modify the Policy in any way. DM-1108-FL.Rev.5.15

18 AAbout the Company National Western Life Insurance Company is a Colorado corporation with Executive Offices in Austin, Texas. The Company offers a full line of life insurance and annuity products (both on an individual and group basis), through independent agency offices in 49 states and the District of Columbia. Visit our website for all current financial information. Since its start in 1956, National Western Life Insurance Company has emphasized financial strength for the protection of its policyholders. As a legal reserve insurance company, National Western Life Insurance Company must set aside a portion of its assets equal to reserves required by law. Annually, a financial statement is filed with each state s insurance department. These departments have the authority to verify, through reviews and audits, that the appropriate reserves are maintained. What Protection am I Receiving on My Financial Outlay? When planning for retirement, or while in retirement, security, stability, financial independence, and peace of mind are important factors you probably desire. The NWL Ultra Future Annuity allows you to take advantage of a monthly average or monthly index changes of the S&P 500 Index. A downturn in the S&P 500 Index alone cannot have a negative impact on the financial outlay of your NWL Ultra Future Annuity Policy. With the NWL Ultra Future Annuity, you can make the most of your retirement and take control of your hard-earned money. Because Americans are living longer and want more satisfying lifestyles during retirement, safe retirement planning is more important today than ever before. It is likely that Social Security and most employer-sponsored qualified retirement plans won t be enough. As a result, you will have to meet part of the challenge with your own savings and money management efforts. The NWL Ultra Future Annuity might be right for you! An annuity is a long-term product designed as an appropriate planning vehicle for retirement security, and can provide you with a series of payments over a period of time. The information in this disclosure brochure will explain the benefits and features of this annuity, and it is to your benefit to read it. Like any annuity issuer, National Western incurs expenses to sell and issue its annuity policies, including compensation to its agents, bonus amounts and/or additional interest (if applicable), option costs, and various other expenses, and these expenses are taken into consideration when interest rates, caps, and participation rates are established and reset. You will receive all benefits as set forth in the contract. To help you fully understand what the NWL Ultra Future Annuity has to offer, National Western requires that your agent review this disclosure brochure with you so that you may ask any questions that you may have. You may also call National Western s Customer Service Department at if you have any questions. National Western Life offers a wide variety of annuity products with different benefits, features, and limitations. Please ask your agent for more information. 1 of 10

19 NWL U L T R F U T U R E What is the NWL Ultra Future Annuity? The NWL Ultra Future Annuity is a flexible premium tax-deferred annuity that combines the safety, benefits, and features of traditional fixed interest deferred annuities while at the same time giving you the option of having your credited interest linked in part to the S&P 500 Composite Stock Index (which excludes dividends). Once credited, your gains are guaranteed for the life of the policy! Enjoy peace of mind with these exceptional benefits: You have the opportunity to have interest accumulation based on a formula linked in part to the S&P 500 Composite Stock Index (which excludes dividends). Your credited gains are locked in each year and cannot be taken away due to future market performance alone.* Your financial outlay is never exposed to market risk and is never reduced because of market fluctuation alone.* You enjoy an increase, if any, based on the S&P 500 Index monthly average or monthly index changes over each Policy Year according to your allocation percentage. *See description of available Withdrawal Benefit Riders and their associated charges What are the Tax Advantages? for any impact they might have on the values in your Policy. Because income taxes are deferred until funds are withdrawn, interest is earned on dollars that might An Illustration of Tax-Deferred Growth otherwise be paid in taxes. This results in greater The graph below is an illustration of the advantages of financial growth than might be possible in a taxable tax-deferred growth. It assumes a one-time $10,000 savings instrument. premium contribution compounding at 6.0% into any In addition to deferring income taxes, you may exercise instru ment that is currently taxable at 28% versus any some control over the ultimate timing of income taxation. Taxes are imposed when funds are withdrawn rently deferred. instrument such as an annuity on which taxes are cur- or paid as a regular income. For the most part, you select the time funds are withdrawn and, therefore, when you are taxed. More importantly perhaps, you 60,000 can select an income settlement option and spread the taxes payable over a number of years. Withdrawals before the owner is may be subject to a 10% income tax penalty. The graph to the right is intended only to illustrate the advantages of tax-deferred growth. Compared are values paying income taxes annually, deferring all income taxes, and paying taxes one time at the end of the period shown. The values represented are not guaranteed. The interest credited to your annuity may be higher or lower and is subject to change. Actual results may be more or less. Non-qualified funds withdrawn are taxed as interest out first. Withdrawals before the owner is may be subject to a 10% income tax penalty. Income tax deferral is provided by any tax-qualified retirement plan. As 50,000 40,000 30,000 20,000 10,000 Growth Taxable Annually Deferred Accumulation Pre Tax Deferred Accumulation After Tax such, the tax-deferred feature of a qualified annuity is redundant. Note that only an annuity can provide an income that cannot be outlived. 10 Years 20 Years 30 Years 2 of 10

20 How Much Initial Money Must I Contribute, and Can I Add More Money Later? You can get all the benefits offered by the NWL Ultra Future Annuity with a minimum initial premium of $5,000 non-qualified and $2,000 qualified. The Initial Premium includes payments up to 20 days from issue. After that you may add premium payments of at least $100, which will earn a non-indexed fixed interest rate until the next Policy Anniversary when those premiums and the interest earned will be added to the Account Value (defined below) for crediting under the Interest Credit Option selected for the next Policy Year. Please note: The Company does have the right to limit premium payments in any renewal year to the amount of premium payments made in the preceding year. 9% First-Year Premium Bonus Each premium payment in the first Policy Year receives a premium bonus of 9%, and each premium payment in Policy Years 2-5 receives a premium bonus of 4.75%. In the Policy, this premium bonus is expressed as a Percentage of Premium, e.g., 109% times each premium payment in the first Policy Year. What are the Values of my Policy? The Contract Value is the greater of the Account Value or the Minimum Guaranteed Contract Value. The Account Value is equal to the premiums received, less any withdrawals and withdrawal charges* on such withdrawals, and less any applicable rider charges and benefits*, accumulated with interest, and, if any, applicable Federal, State, or Municipal taxes, or any fees or assessments required by law. Such interest is based on the Interest Credit Option(s) that you have elected. Regardless of the Interest Credit Option(s) you select or the S&P 500 Index performance, the Minimum Guaranteed Contract Value you will receive will never be less than 87.5% of premiums received, less withdrawals and withdrawal charges, accumulated at the Minimum Guaranteed Interest Rate. The Minimum Guaranteed Interest Rate is set for new policies each calendar quarter. It is the average of the 5 Year Constant Maturity Treasury Rate minus 1.25% for the 6 month period ending 1 month prior to the beginning of the current calendar quarter. It is never less than 1.00%, never greater than 3%, and is guaranteed for the Contract Term. At the end of the Contract Term, the Minimum Guaranteed Interest Rate will be re-determined. The Cash Surrender Value of your policy is the Account Value less the withdrawal charge, if applicable or the Minimum Guaranteed Contract Value, whichever is greater. *Information about withdrawal charges is provided in detail later in this disclosure brochure. See description of available Withdrawal Benefit Riders for more information regarding rider charges and benefits. Do I Have A Choice of Different Interest Options? Yes. The annuity owner can choose one of three different methods or strategies by which to earn interest. These three strategies, Interest Credit Options A, B, and D, are available at issue. Option D is available for the first Policy Year only and will not be available on renewal. Option A may not be available on renewal. Any current Interest Credit Option is effective for the full Policy Year. These interest options are as follows: Option A Equity Indexed Interest-Annual Reset with Monthly Average: Interest on the Account Value is linked in part to the S&P 500 Index. (Note: The index does not include dividends that may be paid on the stocks making up the index.) Option A Indexed Interest is not earned or credited until the Policy Anniversary. Until the Policy Year is over and the necessary 12 monthly Index Values are available, the Option A formula cannot be calculated. Option B Fixed Interest Rate: The interest rate on the portion of the Account Value allocated to Interest Credit Option B is declared in advance by NWL and is guaranteed for the first Policy Year. This interest rate is located on page three of the Policy and includes first-year only additional interest of 0.90%. The interest rate in the first Policy Year will likely be higher than the interest rate in subsequent Policy Years. After the first Policy Year, these interest rates will be declared from time to time and are subject to change. 3 of 10

21 Option D Equity Indexed Interest Annual Reset with Monthly Cap: Interest on the Account Value is linked in part to the S&P 500 Index. (Note: The index does not include dividends that may be paid on the stocks making up the index.) Option D Indexed Interest is not earned or credited until the Policy Anniversary. Until the Policy Year is over and the necessary 12 monthly Index Values are available, the Option D formula cannot be calculated. You may elect to allocate the premium to more than one Interest Credit Option. The Interest Credit Allocation Percentages for available Interest Credit Options can be any whole number percentages, in any combination, whose total is 100%. After My Annuity is Issued, May I Change to a Different Interest Option? Yes. The annuity owner may change to any of the available interest methods for the next Policy Year PRIOR to the Policy Anniversary. A preanniversary notice is mailed to the annuity owner 30 days prior to the Policy Anniversary. To change from the current interest option, he/she is instructed to complete the bottom of the notice, detach it, and mail it back to National Western Life. The notice must be received at our office at least 5 business days prior to the Policy Anniversary for it to be effective for the following Policy Year. If we do not receive notification of a new election within the time period allowed, the previous interest option, if available, will remain in effect. How is the Equity Indexed Interest Calculated? The NWL Ultra Future Annuity has two equity indexing methods. Option A offers an Annual Ratchet feature, Monthly Averaging, first year and renewal year Participation Rates, and first year and renewal year Asset Fee Rates. Option D offers an Annual Ratchet feature, a Monthly Index Change Rate, and a Monthly Index Cap Rate. There is no Asset Fee Rate or Participation Rate on Option D. Let s take a closer look at how these two options work. OPTION A Annual Ratchet Any indexed interest earned is calculated from the beginning Index Value for each Policy Year, whether higher or lower than the previous year. All indexed interest is credited annually on the Policy Anniversary and locked-in. Future decreases in the Index will never reduce your financial outlay. Monthly Averaging National Western Life averages the S&P 500 Index Values corresponding to the 12 Index Dates each Policy Year. The Index Date is the same day each month as the day immediately before the Policy Date at issue. For example, if the Policy Date is August 10th, NWL will average the Index Value for the 9th day of each month beginning with September 9th and concluding for that year with the next August 9th. The Index Value on the Policy Date is the opening value of the Index on that date. The Index Value for subsequent Index Dates is the closing value of the Index on that date. Participation Rate The Participation Rate at issue is guaranteed for the first Policy Year only, as declared by National Western Life. The Participation Rate for subsequent Policy Years is declared on each Policy Anniversary for the following Policy Year. The Participation Rate will likely be higher in the first Policy Year than in subsequent Policy Years. The Participation Rate in subsequent Policy Years is not guaranteed and may be lower than the first Policy Year based on a number of factors, including but not limited to, dividend yields, stock market volatility, and new money interest rate levels. The guaranteed Minimum Participation Rate is 50%. Asset Fee Rate A first year Asset Fee Rate is declared at issue. The Asset Fee will be deducted only in the calculation of Option A equity indexed interest and will never exceed 6.00%. The Asset Fee Rate for subsequent Policy Years is declared each year on the Policy Anniversary and will likely be higher than the first year Asset Fee Rate. The Asset Fee Rate for subsequent Policy Years may fluctuate from year to year as it is influenced by a number of factors, including but not limited, to dividend yields, stock market volatility, and new money interest rate levels. The Asset Fee Rate is not guaranteed and may be subject to change. 4 of 10

22 Equity Indexed Interest Credit Option A Formula: ([( A / B ) x C ] - D) x E than 1%. The interest is credited on the first Policy Anniversary to the Account Value. Annual Ratchet Indexed interest is credited on the first Policy Anniversary and locked-in. A - Index Average for the current Policy Year minus the Index Value on the Prior Anniversary or Policy Date (if Policy is in the first year). B - Index Value on the prior Anniversary or Policy Date (if Policy is in the first year). C - Participation Rate for the Policy Year expressed as a decimal number (100% is 1.0) D - Asset Fee Rate for the Policy Year expressed as decimal number (2% is.02). E - In the first Policy Year, any premiums plus premium bonus received on or before the 20th calendar day following the Policy Date; in Policy Years after the first, the Account Value on the prior Policy Anniversary. Where the formula result is zero or less, the interest credited on the Option A portion of your Account Value will be zero. [See Hypothetical Interest Crediting Examples for Option A on page 6] OPTION D (Available for the first Policy Year ONLY) Monthly Index Change Rate The calculation of the percentage change, either positive or negative, is monthly from Index Date to Index Date. The Index Date is the last day of each monthly period beginning on the Policy Date and the same day of each month thereafter. Monthly Index Cap Rate The interest rate will be the sum of monthly percentage increases and decreases in the index, but the rate credited will not be less than zero (0%). Any single monthly increase will be limited to no greater than the Monthly Index Cap Rate, declared in advance on the Policy Date. The Monthly Index Cap Rate will never be less Hypothetical Interest Crediting Example - Option D Option D Monthly Index Date Index Value Index Change Rate 1/ / % 3/ % 4/ % 5/ % 6/ % 7/ % 8/ % 9/ % 10/ % 11/ % 12/ % 1/ % Assumed Policy Date: January 7 Account Value...$54,500 (Includes any premiums plus premium bonus received on or before the 20th Calendar day following the Policy Date) Index Value on Policy Date Monthly Index Cap Rate % Interest Rate Credited (Sum of Monthly Change Rates from example above) % Multiply by Account Value...$7,254 New Account Value...$61,754 Note: This example is strictly hypothetical and intended to demonstrate only the Option D formula. Example assumes 100% allocation to Option D. 5 of 10

23 Hypothetical Interest Crediting Examples - Option A Examples at the END of the FIRST Policy Year Examples on a Policy ANNIVERSARY after the First Example 1 Example 2 Initial Premium $50,000 $50,000 (Includes any premiums plus premium bonus $4,500 $4,500 received on or before the 20th calendar day $54,500 $54,500 following the Policy Date) (E) Index Value on Policy Date (B) Index Average (Sum /12 from below) Index Average minus Index Value (A) (7.9) Divide Difference (A) by Index Value (B) (0.009) First Year Participation Rate (C) 100% 100% (1.0 as decimal) (1.0 as decimal) Multiply by Participation Rate (C) (0.009) First Year Asset Fee Rate (D) 2% 4% (.02 as decimal) (.04 as decimal) Less Asset Fee Rate Above (0.049) Multiply by Premiums (E) $7,194 ($2,671) Interest Credited under Option A $7,194 $0 Annual Percentage Rate Credited 13.2% 0% Example 1 Example 2 Policy Date: February 5 Policy Date: May 12 Index Date Index Value Index Date Index Value 3/ / / / / / / / / / / / / / / / / / / / / / / / Sum of Values 11,745 Sum of Values 10,945 Average Average Example 3 Example 4 Account Value (E) $50,000 $50,000 Index Value on Prior Policy Date (B) Index Average (Sum /12 below) Index Average minus Index Value (A) Divide Difference (A) by Index Value (B) Renewal Year Participation Rate (C) 70% (0.7 as decimal) 70% (0.7 as decimal) Multiply by Participation Rate (C) Renewal Year Asset Fee Rate (D) 3% 3% (0.03 as decimal) (0.03 as decimal) Less Asset Fee Rate Above Multiply by Acct.Value (E) $600 $2,500 Interest Credited under Option A $600 $2,500 Annual Percentage Rate Credited 1.2% 5.0% Example 3 Example 4 Policy Date: October 10 Policy Date: November 4 Index Date Index Value Index Date Index Value 11/ / / / / / / / / / / / / / / / / / / / / / / / Sum of Values 11,452 Sum of Values 11,894 Average Average Note: These examples are strictly hypothetical and intended to demonstrate only the Option A formula. The abbreviations used in the formula and examples (e.g., A, B, C, D, etc.) may differ from the abbreviations used in the actual Interest Credit Option Endorsements. The Participation Rate and Asset Fee Rate, both first year and renewal years, are assumed for purposes of this example. Example assumes 100% allocation to Option A. 6 of 10

24 What If, After the Annuity is Issued, I Have to Make a Withdrawal? What are my Options? With the NWL Ultra Future Annuity, you have flexibility and a number of liquidity options. Withdrawal Charges This is a long term accumulation annuity. So that National Western Life can provide these accumulation benefits, most of the premium is invested for the long term. If, after the 1st Policy Year, you exceed the 10% penalty-free withdrawal amount explained below, or you surrender this annuity before the end of the 15th Policy Year (unless you take a settlement option after the 1st Policy Year), or you make withdrawals in the 1st Policy Year (with the exception of an IRA Qualified Required Minimum Distribution, Endorsement ), you will incur withdrawal charges. Interest is charged on any withdrawal from the processing date to the next Option Term End Date, if under Option A or D. The withdrawal charge rates by Policy Year are as follows: Withdrawal Options Available to Avoid Withdrawal Charges 10% Penalty-Free Withdrawals each Policy Year after the first Systematic Interest Withdrawals each Policy Year after the first IRA Qualified Required Minimum Distribution in all Policy Years Cash Surrender Value available for Policy Loan (Interest Option B Only) Annuitization of Policy starting after the 1st Policy Anniversary Penalty-Free Partial Withdrawals or Systematic Interest Withdrawals Once each year, after the 1st Policy Year, you may take up to a 10% penalty-free withdrawal ( penalty-free means no withdrawal charges), OR if you prefer, you may elect to make withdrawals of interest earnings without withdrawal charges, limited to the annual amount of interest credited during the prior Policy Year. However, if you should decide to fully surrender this annuity within 12 months of having taken a penalty-free or systematic interest withdrawal, you will incur a retroactive withdrawal charge on that amount at the time of full surrender. IRA Qualified Withdrawal If you have reached the age of 70 1 /2, you may need to begin taking Required Minimum Distributions (RMD) if your NWL Ultra Future Annuity is issued as a tax-qualified plan. Beginning in the first Policy Year, the RMD may be taken penalty-free. See Endorsement Form Withdrawal Charge Rates Policy Issue Issue Issue Issue Issue Issue Issue Issue Issue Issue Issue Issue Issue Issue Issue Year Ages 0-46 Age 47 Age 48 Age 49 Age 50 Age 51 Age 52 Age 53 Age 54 Ages 55 Age 56 Age 57 Age 58 Age 59 Ages % 19.00% 18.25% 17.50% 16.75% 15.75% 15.00% 14.25% 13.25% 14.25% 15.25% 16.25% 17.25% 18.25% 19.25% % 18.25% 17.50% 16.75% 15.75% 15.00% 14.25% 13.25% 12.50% 13.50% 14.50% 15.25% 16.25% 17.25% 18.50% % 17.50% 16.75% 15.75% 15.00% 14.25% 13.25% 12.50% 11.75% 12.50% 13.50% 14.50% 15.50% 16.50% 17.75% % 16.75% 15.75% 15.00% 14.25% 13.25% 12.50% 11.75% 10.75% 11.75% 12.75% 13.75% 14.75% 15.75% 16.75% % 15.75% 15.00% 14.25% 13.25% 12.50% 11.75% 10.75% 10.00% 11.00% 11.75% 12.75% 14.00% 15.00% 16.00% % 15.00% 14.25% 13.25% 12.50% 11.75% 10.75% 10.00% 9.00% 10.00% 11.00% 12.00% 13.00% 14.00% 15.25% % 14.25% 13.25% 12.50% 11.75% 10.75% 10.00% 9.00% 8.25% 9.25% 10.25% 11.25% 12.25% 13.25% 14.50% % 13.25% 12.50% 11.75% 10.75% 10.00% 9.00% 8.25% 7.25% 8.25% 9.25% 10.25% 11.25% 12.50% 13.50% % 12.50% 11.75% 10.75% 10.00% 9.00% 8.25% 7.25% 6.50% 7.50% 8.50% 9.50% 10.50% 11.50% 12.75% % 11.75% 10.75% 10.00% 9.00% 8.25% 7.25% 6.50% 5.50% 6.50% 7.50% 8.50% 9.75% 10.75% 12.00% % 10.00% 10.00% 9.00% 8.25% 7.25% 6.50% 5.50% 4.50% 5.50% 6.50% 7.75% 8.75% 10.00% 10.00% % 8.00% 8.00% 8.00% 7.25% 6.50% 5.50% 4.50% 3.75% 4.75% 5.75% 6.75% 8.00% 8.00% 8.00% % 6.00% 6.00% 6.00% 6.00% 5.50% 4.50% 3.75% 2.75% 3.75% 4.75% 6.00% 6.00% 6.00% 6.00% % 4.00% 4.00% 4.00% 4.00% 4.00% 3.75% 2.75% 1.75% 2.75% 4.00% 4.00% 4.00% 4.00% 4.00% % 2.00% 2.00% 2.00% 2.00% 2.00% 2.00% 1.75% 0.75% 2.00% 2.00% 2.00% 2.00% 2.00% 2.00% Note: Withdrawal charge rates are calculated individually at certain issue ages to comply with nonforfeiture laws. 7 of 10

25 Please note: Only one of the three aforementioned options may be elected in the same Policy Year. Remember, all withdrawals are subject to federal income tax. Withdrawals prior to age may be subject to an additional 10% income tax penalty, and if a trust is named as the owner, such withdrawals may be subject to this additional 10% income tax penalty regardless of age. Cash Loan Privilege Endorsement Form XP(REV.FL/06) Starting the 2nd Policy Month, a policy loan may be taken up to the Cash Surrender Value less any prior loans and loan interest if the Interest Credit Allocation Percentage for Interest Credit Option B is 100%. Loans are not available if an Indexed Interest Credit Option is in effect. In addition, any loan would have to be repaid before an Indexed Interest Credit Option could be elected. All or part of a loan may be repaid at any time, but each payment must be at least $25. The interest on the loan must be paid annually at 7.4% in advance. If not, the interest will be added to the amount of the loan. Also, cash loans are not available for IRAs or Roth IRAs or for some other qualified plans. If any amount is owed to us when a settlement option is elected or upon the Annuitant s death, whichever occurs first, such amount will be treated as a partial withdrawal and subject to withdrawal charges. See endorsement for complete information; certain limitations and exclusions may apply. Income Settlement Options at Annuity Date You may elect to receive the Contract Value under an Income Settlement Option on the Annuity Date. You may choose an Annuity Date that occurs as early as the end of the 1st Policy Anniversary. At this time you may elect to receive payments under one of the many available options, including but not limited to: Income for a specific number of years (minimum as specified in your Policy), or Income for as long as you live, or Income for as long as you and your joint annuitant live. A guaranteed interest rate of 1.25% will be used in calculating these payments. National Western Life may, at its option, use an interest rate that is higher than the guaranteed rate. See the Policy for complete details of these options. What Happens If I Keep My Annuity for 15 Years and am Still Not Ready to Take the Money Out? At the end of the 15-year Contract Term, you may withdraw the full Contract Value without any withdrawal charges, take a partial withdrawal, or elect an income settlement option. You do have the right to keep the Account Value with National Western Life for the rest of your life where it will continue to earn interest at a rate not less than the Minimum Guaranteed Interest Rate that has been re-determined at the end of your Contract Term. What Will Happen if the Annuitant Dies? The NWL Ultra Future Annuity provides a death benefit payable to the named Beneficiary. If the Annuitant s death occurs before the Annuity Date, the Beneficiary will receive the Contract Value as a single sum, OR the Beneficiary can elect to receive the Contract Value applied under one of the Income Settlement Options. If the Annuitant dies on or after the Annuity Date, the Beneficiary will receive any unpaid guaranteed amounts as provided by the Income Settlement Option in force on the date of death. The death benefit paid to the Beneficiary (except for the estate) may pass without the costs and delays of probate. What Other Benefits or Features of this Annuity Should I Know About? Free Look Period Your satisfaction is important to us! If you change your mind about whether this annuity fits your needs after you receive your annuity Policy or if you are dissatisfied for any reason, you have at least twenty days* after receipt of the annuity Policy during which you can return it without incurring charges (referred to as a free look period). 8 of 10

26 *This time period may be longer; please see your Policy for details. 109% of the premium is credited to the Account Value in the first Policy Year. If applicable, each premium or Settlement Option value will be reduced by the amount of premium taxes, fees, or legal assessments imposed by the state or government jurisdiction where you purchase this annuity. Please remember that withdrawal charges may apply for early withdrawals. Available Withdrawal Benefit Riders Depending on the state, there may be up to 2 different Withdrawal Benefit Riders available that offer different benefits and have different charges. Income Outlook has a basic set of lifetime income benefits and has annual charges that are applied only if interest credited to the Policy to which it is attached can cover them. Income Outlook Plus 5 also provides for lifetime income benefits and includes a bonus, but the charges are applied annually regardless of the amount, if any, of interest credited to the Policy to which it is attached. Please refer to the separate consumer disclosure brochure for the appropriate rider elected for a more complete description of the benefits and features of these riders and applicable charges. Annual Report Each Policy Year, you will receive an annual report. The detailed status will show the following: Premium received during the Policy Year Withdrawals during the Policy Year Interest credited during the Policy Year Account Value Contract Value Cash Surrender Value Legal and Tax Advice National Western Life Insurance Company does not authorize its agents or employees to give legal or tax advice. Representations made in this disclosure brochure are based on our understanding of current tax law relative to the NWL Ultra Future Annuity. For an explanation of how those laws apply to you, we suggest you consult with your attorney, accountant, or other tax advisor. NWL Ultra Future Annuity The NWL Ultra Future Annuity is underwritten by National Western Life Insurance Company, Austin, Texas and issued under Policy Form FL. Certain other limitations and exclusions may apply. Standard and Poor s The S&P 500 Composite Stock Price Index (S&P 500 Index) is a market valued-weighted index of 500 common stocks traded on every major U.S. Stock Exchange. These 500 companies tend to be leading companies from leading industries. Often used as a benchmark for economic growth, the S&P 500 is compiled daily by Standard & Poor s, a division of the McGraw-Hill Companies. Standard & Poor s, S&P, S&P 500, Standard & Poor s 500, and 500 are trademarks of The McGraw-Hill Companies, Inc. and have been licensed for use by National Western Life Insurance Company. The NWL Ultra Future Annuity is not sponsored, endorsed, sold, or promoted by Standard & Poor s, and Standard & Poor s makes no representation regarding the advisability of purchasing this product. 9 of 10

27 NATIONAL WESTERN LIFE INSURANCE COMPANY NWL ULTRA FUTURE ANNUITY Consumer Disclosure Brochure Signatures Thank you for choosing to purchase the NWL Ultra Future Flexible Premium Deferred Equity Indexed Annuity. If you have any questions after you receive your annuity Policy, please contact your agent or call National Western s Customer Service Department at We want to be sure that you read all 10 pages of this disclosure brochure and are aware of the benefits and features explained herein. Please initial and sign where indicated with an asterisk (*), acknowledging that you understand the following: This is a deferred annuity, and it is a long-term savings vehicle. This annuity has a free look period, during which you can surrender the annuity Policy after receiving it without incurring surrender charges (described more fully in your annuity Policy). Any results shown, other than guaranteed minimum values, are not guarantees, promises, or warranties. Withdrawal charges may be deducted from your Account Value. If applied for, the annual charge for a Withdrawal Benefit Rider may be deducted from your Account Value. Your agent receives compensation for the sale of this annuity policy. 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 50% 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, or D. You can allocate in any combination among Option A, B, or D (must be whole numbers whose sum is 100%). Interest Credit Option D will not be available after the first Policy Year. State your allocation percentage here. % Option A % Option B % Option D Option A may not be available on renewal. The above-stated features have been fully explained to me. (*Initial) I have received a copy of this disclosure brochure, and I have reviewed it with my agent. I fully understand the disclosure brochure and the specific points outlined above. The disclosure brochure is not a part of the annuity Policy and does not modify it in any way. The annuity Policy itself contains all terms, benefits, guarantees, limitations, restrictions, and exclusions. NATIONAL WESTERN LIFE INSURANCE COMPANY NWL ULTRA FUTURE ANNUITY Consumer Disclosure Brochure Signatures Thank you for choosing to purchase the NWL Ultra Future Flexible Premium Deferred Equity Indexed Annuity. If you have any questions after you receive your annuity Policy, please contact your agent or call National Western s Customer Service Department at We want to be sure that you read all 10 pages of this disclosure brochure and are aware of the benefits and features explained herein. Please initial and sign where indicated with an asterisk (*), acknowledging that you understand the following: This is a deferred annuity, and it is a long-term savings vehicle. This annuity has a free look period, during which you can surrender the annuity Policy after receiving it without incurring surrender charges (described more fully in your annuity Policy). Any results shown, other than guaranteed minimum values, are not guarantees, promises, or warranties. Withdrawal charges may be deducted from your Account Value. If applied for, the annual charge for a Withdrawal Benefit Rider may be deducted from your Account Value. Your agent receives compensation for the sale of this annuity policy. 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 50% 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, or D. You can allocate in any combination among Option A, B, or D (must be whole numbers whose sum is 100%). Interest Credit Option D will not be available after the first Policy Year. State your allocation percentage here. % Option A % Option B % Option D Option A may not be available on renewal. The above-stated features have been fully explained to me. (*Initial) I have received a copy of this disclosure brochure, and I have reviewed it with my agent. I fully understand the disclosure brochure and the specific points outlined above. The disclosure brochure is not a part of the annuity Policy and does not modify it in any way. The annuity Policy itself contains all terms, benefits, guarantees, limitations, restrictions, and exclusions. *Applicant s Signature Date *Applicant s Signature Date I certify that I reviewed this disclosure brochure with the applicant. I certify that I reviewed this disclosure brochure with the applicant. Agent s Signature & Agent No. DM-1108-FL.Rev.5.15-SIG Applicant to Retain 10 of 10 Date Agent s Signature & Agent No. Date Submit with Application DM-1108-FL.Rev.5.15-SIG

28 CLIENT SERVICES TOLL-FREE FAX CLIENT SERVICES TOLL-FREE FAX

29 DEPARTMENT OF FINANCIAL SERVICES Division of Agent & Agency Services - Bureau of Investigation DISCLOSURE AND COMPARISON OF ANNUITY CONTRACTS EXISTING ANNUITY CONTRACT PROPOSED ANNUITY CONTRACT Annuitant(s) Insurer Annuitant(s): Insurer: Contract # Application #: EXISTING ANNUITY CONTRACT REPLACEMENT ANNUITY Contract Issue Date Mo Day Yr Mo Day Yr (Est) Generic Contract Type Marketing Name Initial Premium Source of Initial Premium N/A Qualified Contract? Yes No Yes No Annuity Maturity Date Death Benefit Amount Change of Annuitant upon Death Available? Yes No Yes No Surrender Charge Period in Years First Year Surrender Charge Percentage Rate % % Surrender Charge Schedule for Remaining Years Free Withdrawals Available? Yes No Yes No Annual Free Withdrawal Percentage Rate % % Potential tax penalty for surrender/sale/ exchange/annuitization (Describe) Investment/Insurance components (Describe) Waiver of Surrender Charge Benefit or Similar Benefit? Yes No Yes No Riders, Features/Cost (Describe) Loss of Benefits or Enhancements if existing contract exchanged? (Describe) DM-1118-FL.Rev DFS-H Page 1 of 5 Rule 69B , F.A.C. Effective 10/21/2014

30 Living Benefits (Describe) EXISTING ANNUITY CONTRACT REPLACEMENT ANNUITY Minimum Guaranteed Interest Rate % % Limitations on interest returns (Describe) Interest Rate Cap / Term / / Participation Rate / Term / / Indexing Method / Term / / Other Fees (Describe) Initial Bonus Percentage or Amount Potential Loss of Bonus if Exchanged? Yes No Yes No Limits and Exclusions for Bonuses that may be payable (Describe) Comments and continuation from above: Owner s Signature Date Signed DFS-H Page 2 of 5 Adopted in Rule 69B , F.A.C. Effective 10/21/2014

31 DISCLOSURE OF SURRENDER CHARGES IF EXISTING ANNUITY IS REPLACED OR EXCHANGED EXISTING ANNUITY CONTRACT NO. Annuity Total Value $ Annuity Surrender Value $ Surrender Charges Applicable at exchange $ ~ this is the estimated amount that will be deducted from the existing annuity s total value if surrendered, replaced, or exchanged, with an anticipated surrender date of / /. Have you surrendered or exchanged an annuity contract in the last 36 months? If yes, provide details: Yes No ACKNOWLEDGEMENTS AND SIGNATURES I acknowledge that I have provided the Applicant with a completed and signed copy of this form. Agent s Name (please print) Florida License No. Agent s Signature Date Signed NOTE: NO QUESTIONS OR RESPONSE AREAS ARE TO BE LEFT BLANK WHEN OFFERED TO THE ANNUITANT AND/OR APPLICANT FOR SIGNATURE. IF ANY INFORMATION REQUESTED IS UNAVAILABLE, NOT APPLICABLE OR UNKNOWN, THE INSURANCE AGENT OR INSURER MUST INDICATE THAT. THE OWNER MAY SUBSTITUTE THEIR INITIALS FOR SIGNATURES ON ALL FORM PAGES WITH THE EXCEPTION OF THE SIGNATURES BELOW, WHICH ARE REQUIRED. APPLICANT: DO NOT SIGN THIS FORM IF: 1. ANY ITEM HAS BEEN LEFT BLANK; 2. WITHOUT CAREFULLY REVIEWING THE INFORMATION RECORDED; OR 3. IF ANY OF THE INFORMATION RECORDED IS NOT TRUE AND CORRECT TO THE BEST OF YOUR KNOWLEDGE. Owner s Name (please print) Owner s Signature Date Signed DFS-H Page 3 of 5 Adopted in Rule 69B , F.A.C. Effective 10/21/2014

32 EXPLANATION OF TERMS Generic Contract Type is the generic name of the annuity contract form as approved by the Florida Office of Insurance Regulation. Examples of generic annuity contract names are Flexible Premium Equity Indexed Annuity (FPEIDA), Single Premium Immediate Annuity (SPIA), Flexible Premium Variable Deferred Annuity (FPVDA), and Single Premium Deferred Annuity (SPDA). Marketing Name is the name adopted by the insurer to identify the contract form. Qualified Contract means a product used to fund any type of pension plan approved by the Internal Revenue Service. Annuity Maturity Date is the final date of termination of the contract at which time the proceeds of the contract must be paid out. Surrender Charge is the amount deducted from annuity contract values upon surrender of an annuity, or for withdrawals exceeding any free withdrawal provision of the contract, regardless how this charge is titled in the policy, e.g., deferred sales charge. Surrender Charge Period is the number of annuity contract years a surrender charge may be applicable. Initial Surrender Charge Percentage Rate is the original percentage rate that is deducted from annuity values at the inception of the existing annuity contract, or that will be deducted from the recommended replacement contract at its inception if purchased. Surrender Charge Percentage Schedule for Remaining Years the percentage rate that would be deducted from the existing annuity contract if surrendered, or for any withdrawals exceeding the free withdrawal limit. Minimum Guaranteed Interest Rate is the minimum interest rate payable under the annuity contract as guaranteed by the insurer in the annuity contract. Initial Bonus Percentage or Amount is a bonus paid by the insurer, generally, at inception of the annuity contract, and may be expressed as a percentage of the initial premium or other amount, or a dollar amount, and must be stated in the annuity contract. Potential Loss of Bonus if Exchanged refers to whether any bonus would be lost if the annuity contract was exchanged or terminated for any reason. Interest Rate Cap this is the maximum rate of interest the annuity will earn. Owner s Signature Date Signed DFS-H Page 4 of 5 Adopted in Rule 69B , F.A.C. Effective 10/21/2014

33 EXPLANATION OF TERMS (CONTINUED) Participation Rate the participation rate decides how much of the increase in the index will be used to calculate index linked interest. Indexing Method means the approach used to measure the amount of change, if any, in the index and includes annual reset (ratcheting), high-water mark and point-to-point. The index term is the period over which index-linked interest is calculated. Market Value Adjustment is the increase or decrease in the surrender value of the contract that is adjusted to reflect market fluctuations. Administrative Fees or Margins are charges that amount to the difference between the percentage gain in the index and the actual amount credited to the annuity contract. Asset Fees are the fees the insurer charges that are a percentage of the value of the annuity contract. Death Benefit Amount is the net amount that would be paid to the annuitant s designated beneficiary or beneficiaries of an existing annuity, or the death benefit that the proposed replacement policy would pay as of the contract issue date. Free Withdrawals are the withdrawals that may be taken from an annuity s values that are not subject to surrender or other charges and are a provision of the annuity contract. Annual Free Withdrawal Percentage Rate is the percentage of available funds that may be withdrawn from an annuity contract, generally on an annual basis and is stated in the annuity contract. Change of Annuitant upon Death is a provision that allows another person to become the annuitant upon the death of the original annuitant allowing the contract to remain in force. Waiver of Surrender Charge Benefit or Similar Benefit or Provision is a benefit that is built into individual annuity contracts or added by rider, endorsement or amendment. The benefits are triggered by a qualifying event associated with either the annuitant or owner, as specified in the contract. Owner s Signature Date Signed DFS-H Page 5 of 5 Adopted in Rule 69B , F.A.C. Effective 10/21/2014

34

35 DEPARTMENT OF FINANCIAL SERVICES Division of Agent & Agency Services - Bureau of Investigation ANNUITY SUITABILITY QUESTIONNAIRE Owner: Last First Middle Date of Birth / / Age Sex Entity: Tax Status Relationship to Annuitant(s): Form of Ownership: Supporting documents (list): Annual Income: Source of Income: Annual Household Income: Existing Assets Existing Liquid Net Worth: Do you currently own any annuities? Please list: Yes No Do you currently own life insurance? Please list: Yes No Does your income cover all your living expenses including medical? Yes No Do you expect changes to your living expenses? Yes No Do you anticipate changes in your out-of-pocket medical expenses? Yes No Is your income sufficient to cover future changes in your living and/or out-of-pocket medical expenses during the surrender charge period? Yes No Do you have an emergency fund for unexpected expenses? Yes No Why are you purchasing this annuity? What are your financial objectives for this purchase? (Check all that apply) Income Growth (long term) Safety of Principal and Income Safety of Principal and Growth Pass assets to a beneficiary or beneficiaries at death Other: Owner s Signature Date Signed DFS-H Effective 10/21/2014 DM-1119-FL.Rev Rule 69B , F.A.C.

36 Describe your risk tolerance: (Check all that apply) Conservative Moderately conservative Moderate Moderately aggressive Aggressive Other: Comments: Describe your investment experience by type and length of time: What is the source of the funds for the purchase of the proposed annuity? How many years from today will you need access to your funds without a penalty? Will the proposed annuity replace any product? Yes No If yes, will you pay a penalty or other charge to obtain these funds? Yes No If yes, the amount of the charge or penalty $ Additional Information: Owner s Signature Date Signed DFS-H Effective 10/21/2014 Page 2 of 4 Rule 69B , F.A.C.

37 Note: The following three sections to be completed by the agent, insurer, or Managing General Agent proposing purchase; each section requires a response; no section may be left blank or contain a response consisting of None or N/A. Advantages of purchasing the proposed annuity: Disadvantages of purchasing the proposed annuity: The basis for my recommendation to purchase the proposed annuity or to replace or exchange your existing annuity (ies): Agent s Signature Date Signed Note: No questions or response areas are to be left blank when offered to the Owner for signature. If any information requested is unavailable, not applicable or unknown, the insurance agent or insurer must indicate that. ACKNOWLEDGEMENTS AND SIGNATURES I understand that should I decline to provide the requested information or should I provide inaccurate information, I am limiting the protection afforded me by the Florida Statutes regarding the suitability of this purchase. I REFUSE to provide this information at this time. I have chosen to provide LIMITED information at this time. My annuity purchase IS NOT BASED on the recommendation of this agent or the insurer. My annuity purchase IS BASED on the recommendation of this agent or the insurer. APPLICANT: DO NOT SIGN THIS FORM IF ANY ITEM HAS BEEN LEFT BLANK, BEFORE CAREFULLY REVIEWING THE INFORMATION RECORDED, OR IF ANY OF THE INFORMATION RECORDED IS NOT TRUE AND CORRECT TO THE BEST OF YOUR KNOWLEDGE. THE OWNER MAY SUBSTITUTE THEIR INITIALS FOR SIGNATURES ON ALL FORM PAGES WITH THE EXCEPTION OF THE SIGNATURES BELOW, WHICH ARE REQUIRED. Owner s Signature Date Signed DFS-H Effective 10/21/2014 Page 3 of 4 Rule 69B , F.A.C.

38 EXPLANATION OF TERMS Age is the natural person s attained age on the day the form is completed. Tax Status is the owner s Federal Income Tax filing status such as single or married filing jointly ; if Exempt, so state. Form of Ownership is the type of entity, other than a natural person, including a corporation, trust, partnership, limited liability company, or other business or not-for-profit entity. Supporting documents are the documents that provide a basis for the relationship between the Proposed Annuitant, and the Owner as it may exist. Annual income is income received during a calendar year, whether earned or unearned. Source of annual income is the income-generating source, such as pension income, dividends, or earned income etc. Annual household income is the combined annual income received by all household members each calendar year. Existing Assets are financial assets including life insurance and annuities. Existing Liquid Net Worth is applicable to those net assets that can readily be converted into their cash equivalent, without loss of principal after all surrender charges or other deductions have been taken. Financial Objectives are the owner s stated goals as described to the insurance agent or insurer, if no insurance agent is involved. These may include but are not limited to the following: (1) Income, (2) Growth (long term capital appreciation), (3) Safety of Principal and Income, (4) Safety of Principal and Growth, (5) To pass the investment to a beneficiary or beneficiaries at death. Risk Tolerance means the degree of uncertainty that an investor can reasonably tolerate with regard to a negative change in his or her investments. Examples of risk tolerance levels may include the following: (1) Conservative (prefer little or no risk), (2) Moderately conservative (some risk, reduced safety of principal), (3) Moderate (average risk with potential losses and potentially higher returns), (4) Moderately aggressive (above average risk with potential losses, risk of principal and potentially higher returns), (5) Aggressive (willing to sustain losses or loss of principal in pursuit of higher returns). Source of the funds to be used to purchase the proposed annuity means from where the funds will come to purchase the annuity, and may include but are not limited to; (1) An existing annuity or life insurance contract, (2) Liquid Assets, including but not limited to, cash in banks, maturing certificates of deposit, and money market accounts, (3) Personal Loans, (4) Equity Loans, (5) Mortgages, Reverse Mortgages, (6) Death Benefit Proceeds, (7) Funds received upon retirement from employment, including but not limited to, 401(k) accounts, pensions, and other tax-sheltered funds, (8) Equities, mutual funds, or bonds, (9) Proceeds from real estate transactions. Owner s Signature Date Signed DFS-H Effective 10/21/2014 Page 4 of 4 Rule 69B , F.A.C.

39 NWL s Withdrawal Benefit Rider Still A Sure WIN to Provide Security For Your Withdrawal Income Needs! Optional Benefit Available on Indexed Annuities DM-1120.Rev.1.13 National Western Life Insurance Company 850 East Anderson Lane Austin, Texas 78752

40 INCOME OUTLOOK PLUS 5 NWL s Next Generation Benefit Rider Enjoy the benefits of guaranteed lifetime retirement income with enhanced accumulations and control of your annuity! National Western Life requires that the Agent review this entire brochure with you. NWL s Income Outlook Plus 5 provides: Great growth potential for your lifetime Withdrawal Payments Control of when your Withdrawal Payments begin Guaranteed Withdrawal Percentages that increase at selected ages Access to your money for Additional Withdrawals remains Guaranteed Withdrawal Payments for life anytime after the age of 60! Adding Income Outlook Plus 5 to your National Western Life indexed annuity at purchase will give you all of these benefits. This withdrawal benefit rider works with all of your annuity s traditional benefits and enhances the benefits with guaranteed Withdrawal Payments you cannot outlive. INCOME OUTLOOK PLUS 5 HIGHLIGHTS Income Outlook Plus 5 guarantees during the Accumulation Period: 4% interest on the Accumulation Period Withdrawal Payment Base until lifetime Withdrawal Payments begin 5% Rider Bonus on the premiums received in the first Policy Year subject to the Rider Bonus Vesting Schedule The Guaranteed Withdrawal Percentages increase at every fifth age until age 90 or until the lifetime Withdrawal Payments begin Access to the annuity s Account Value remains The option to Restart the ten year Accumulation Period at the end of the fifth Policy Year Income Outlook Plus 5 guarantees during the Withdrawal Period: Withdrawal Payments that can be paid for life The ability to stop and start Withdrawal Payments No withdrawal charges on Withdrawal Payments taken under this rider The Withdrawal Payment Base to Step-Up to the annuity s Account Value* if larger, when the Withdrawal Period begins and each Policy Anniversary thereafter The Maximum Guaranteed Annual Withdrawal Payment increases each time there is a Step-Up in the Withdrawal Payment Base Access to the annuity s Account Value remains Required Minimum Distribution friendly *If the base annuity policy has a premium bonus that is not included in the Account Value, then for purposes of Restart, Step-Up, and Withdrawal Payment Base, the Account Value will be increased by any applicable base annuity Vested Bonus Value. Page 2

41 INCOME OUTLOOK PLUS 5 DETAILS Income Outlook Plus 5 is available to add as a rider to your National Western Life indexed annuity only at the time of purchase. The Withdrawal Payment is the amount you choose to receive each year. The Maximum Guaranteed Annual Withdrawal Payment is guaranteed to be paid for your lifetime if no Additional Withdrawals are taken. Your age must be at least 60 before Withdrawal Payments may begin. You may begin taking Withdrawal Payments as early as the first Policy Anniversary or any Policy Anniversary you choose after that. The Withdrawal Payments taken under this rider are deducted from the annuity s Account Value and will not incur any withdrawal charges. There is an Annual Rider Charge for this benefit on each Policy Anniversary, beginning with the first. The Annual Rider Charge Rate is determined on the Policy Date and is shown on page 1 of the rider. This rate is guaranteed not to change while this rider is in force unless Restart (as described below) is elected and will never exceed the maximum rate of 1.5%. There is a Rider Bonus added to the Accumulation Period Withdrawal Payment Base. The Rider Bonus is the Rider Bonus Rate shown on Page 1 of the rider multiplied by the premium received during the first Policy Year. The Rider Bonus is credited with interest at the same rate as the Account Value of the Policy. The Rider Bonus is available on a pro-rata basis based on the Rider Bonus Vesting Schedule shown on Page 1 of the rider and described on page 6 of this disclosure for Additional Withdrawals, full surrender, or annuitization of the Policy. This means the Rider Bonus will not be available in all Policy Years, as described more fully on page 6 of this disclosure. The Rider Bonus is fully included in the Account Value for purposes of the Death Benefit. Page 3

42 The Income Outlook Plus 5 rider has two periods, the Accumulation Period and the Withdrawal Period. Each period is described as follows. During the Accumulation Period The Accumulation Period Withdrawal Payment Base has a 4% interest rate that is guaranteed each year during the Accumulation Period. The Accumulation Period Withdrawal Payment Base initially equals the premium paid, plus any applicable premium bonus. Additional premiums paid and premium bonuses, if applicable, will be added to the Accumulation Period Withdrawal Payment Base when they are received. Withdrawals made from the Account Value will reduce the Accumulation Period Withdrawal Payment Base. As the Payment Base grows, so do your guaranteed Withdrawal Payments for life. Restart During the Accumulation Period, you may Restart the 4% guaranteed interest rate anytime after the fifth Policy Year. At the time you Restart the Accumulation Period, the following will happen: The 4% guaranteed interest rate on the Accumulation Period Withdrawal Payment Base will be guaranteed from Restart; The Accumulation Period Withdrawal Payment Base will be increased to the annuity s Account Value*, if larger; and The Annual Rider Charge Rate may change, but will not be higher than the maximum guaranteed charge of 1.5%. You must wait five years after each Restart before beginning a new Accumulation Period. *If the base annuity policy has a premium bonus that is not included in the Account Value, then for purposes of Restart, Step-Up, and Withdrawal Payment Base, the Account Value will be increased by any applicable base annuity Vested Bonus Value. Withdrawals Withdrawals may be made at anytime as provided by the annuity. Withdrawals from your annuity will reduce the Accumulation Period Withdrawal Payment Base by the same percentage reduction made to the annuity s Account Value. Page 4

43 Example: A $20,000 withdrawal is made. The Account Value is $250,000 before the withdrawal. After the withdrawal the Account Value is $230,000, or 92% of the Account Value before the withdrawal. The Accumulation Period Withdrawal Payment Base is $240,000 before the withdrawal. It is multiplied by 92% and equals $220,800 after the Withdrawal. Account Value $250,000-20,000 $230, , ,000 = 92% $240,000 x.92 $220,800 Accumulation Period Withdrawal Payment Base The Accumulation Period ends when you begin taking Withdrawal Payments. At that time, the Withdrawal Period begins. During the Withdrawal Period The Withdrawal Payment amount you choose to receive is guaranteed to be paid for your lifetime if it does not exceed the Maximum Guaranteed Annual Withdrawal Payment. The Maximum Guaranteed Annual Withdrawal Payment will remain level unless there is a Step-Up in the Withdrawal Payment Base, or you take an Additional Withdrawal. You may receive your Withdrawal Payment annually, semi-annually, quarterly, or monthly. Each payment must be at least $100. Any election to start or stop Withdrawal Payments must be received at National Western Life Insurance Company at least 20 days prior to the Policy Anniversary. When the Withdrawal Period begins: The Guaranteed Withdrawal Percentage is determined; The Withdrawal Payment Base is increased to the annuity s Account Value* if it is larger; The Maximum Guaranteed Annual Withdrawal Payment is calculated; Any outstanding loan must be repaid; No more loans or Systematic Withdrawals of Interest from the Account Value of the Policy may be taken; and Any applicable penalty-free withdrawal amount that is available each Policy Year under the base annuity policy will be reduced by the Withdrawal Payment. *If the base annuity policy has a premium bonus that is not included in the Account Value, then for purposes of Restart, Step-Up, and Withdrawal Payment Base, the Account Value will be increased by any applicable base annuity Vested Bonus Value. The Guaranteed Withdrawal Percentage is based on your age at the beginning of the Withdrawal Period. This percentage will not change during the Withdrawal Period. The Maximum Guaranteed Annual Withdrawal Payment equals the Withdrawal Payment Base multiplied by the Guaranteed Withdrawal Percentage. Example: Five years ago, you purchased an annuity with Income Outlook Plus 5 with $100,000 and have now decided to begin Withdrawal Payments. The Withdrawal Payment Base is now $121,665 after five years of 4% interest and your Guaranteed Withdrawal Percentage is 6.5%. At this time, your Maximum Guaranteed Annual Withdrawal Payment is $7,908 and your annuity s Account Value is $131,317. Therefore, the Withdrawal Payment Base is increased to the Account Value and your Maximum Guaranteed Annual Withdrawal Payment is $8,536. Page 5

44 Step-Up On each Policy Anniversary during the Withdrawal Period, the Withdrawal Payment Base will be compared to the annuity s Account Value*. If the Account Value* is larger than the Withdrawal Payment Base, the Withdrawal Payment Base will Step-Up to the Account Value*. Following the Step-Up, the Maximum Guaranteed Annual Withdrawal Payment is recalculated and increased, based on this higher Withdrawal Payment Base. These payments are guaranteed for your lifetime. Example: At the end of two years of Withdrawal Payments, your annuity s Account Value has grown to $132,725. Your Withdrawal Payment Base of $131,317 will Step-Up to $132,725. The Maximum Guaranteed Annual Withdrawal Payment will be increased to $8,627, which equals the Withdrawal Payment Base of $132,725 multiplied by the Guaranteed Withdrawal Percentage of 6.5%. *If the base annuity policy has a premium bonus that is not included in the Account Value, then for purposes of Restart, Step-Up, and Withdrawal Payment Base, the Account Value will be increased by any applicable base annuity Vested Bonus Value. Additional Withdrawals An Additional Withdrawal is any withdrawal that is not a Withdrawal Payment and may be made at anytime during the Withdrawal Period. Additional Withdrawals reduce the Withdrawal Payment Base and Withdrawal Payments using the pro-rata adjustment factor. The pro-rata adjustment factor is based on the change in Account Value due to the Additional Withdrawal. The Maximum Guaranteed Annual Withdrawal Payment will change to equal the Guaranteed Withdrawal Percentage multiplied by the Withdrawal Payment Base after the Additional Withdrawal. The new Maximum Guaranteed Annual Withdrawal Payment will become effective on the Policy Anniversary following the Additional Withdrawal. Rider Bonus Vesting Schedule For purposes of Additional Withdrawals, full surrenders, or annuitization, the Rider Bonus is available on a pro-rata basis based on the Rider Bonus Vesting Schedule shown on Page 1 of the Rider and detailed below: Rider Bonus Vesting Schedule Policy Years 1-7 [0%] Policy Year 8 [25%] Policy Year 9 [50%] Policy Year 10 and later [100%] Therefore, in accordance with the Rider Bonus Vesting Schedule above, if you take any Additional Withdrawals, fully surrender, or annuitize pursuant to the terms of the Policy/Contract to which this rider is attached, no portion of the Rider Bonus will be available to you in years 1-7, and only a limited portion will be available in years 8 and 9. Beginning in Policy Year 10, the full Rider Bonus will be available. Required Minimum Distributions (RMDs) If the RMD payment is greater than the Maximum Guaranteed Annual Withdrawal Payment, the additional amount withdrawn to meet the RMD payment will not be considered an Additional Withdrawal. Page 6

45 How Is The Maximum Guaranteed Annual Withdrawal Payment (MGAWP) Calculated? Policy Years Annuitants Age Scenario 1 Scenario 2 Scenario 3 Age 65-1 Year Accumulation Age 65-5 Year Accumulation Age Year Accumulation Withdrawal Payment Base Guaranteed Withdrawal Percentage MGAWP Withdrawal Payment Base Guaranteed Withdrawal Percentage MGAWP Withdrawal Payment Base , , , , % 6, , , , % 6, , , , % 6, , , , % 6, , , , % 6, , % 7, , , % 6, , % 7, , , % 6, , % 7, , , % 6, , % 7, , , % 6, , % 7, ,448 Guaranteed Withdrawal Percentage MGAWP , % 6, , % 7, , % 10, , % 6, , % 7, , % 10, , % 6, , % 7, , % 10, , % 6, , % 7, , % 10, , % 6, , % 7, , % 10, , % 6, , % 7, , % 10,103 This is a hypothetical example that illustrates values for a single annuitant. This example does not demonstrate an actual crediting scenario and is not a projection of the future results. Page 7

46 ADDITIONAL DETAILS Issue Ages Income Outlook Plus 5 may be added to the annuity only at the time of purchase, regardless of age. Premium Allocation Premiums may be allocated to any Interest Credit Options and in any combination that is allowed by the annuity. All premiums paid during the Accumulation Period are guaranteed to be included in the Accumulation Period Withdrawal Payment Base and will receive the 4% guaranteed interest rate. Annuitants The Annuitant and Joint Annuitant, if any, cannot be changed after the annuity is issued. Two annuitants are allowed on this rider only. The Withdrawal Payment is guaranteed to be paid until the death of the last surviving annuitant. The Guaranteed Withdrawal Percentage is based on the age of the younger annuitant. Guaranteed Withdrawal Percentages The Guaranteed Withdrawal Percentage is based on your age on the Policy Anniversary that you begin Withdrawal Payments. The table below has the Guaranteed Withdrawal Percentages for a single annuitant. Age Percentage % % % % % % % The table below has the Guaranteed Withdrawal Percentages when there are joint annuitants. The percentage is based on the age of the younger annuitant on the Policy Anniversary that you begin Withdrawal Payments. Age Percentage % % % % % % % Page 8

47 $100,000 Premium Maximum Guaranteed Annual Withdrawal Payments - Single Annuitant Issue Age Number of Full Years of Accumulation before Withdrawal Payments Begin ,460 5,678 5,906 6,142 7,026 7,307 7,600 7,903 8,220 9, ,460 5,678 5,906 6,756 7,026 7,307 7,600 7,903 8,967 9, ,460 5,678 6,496 6,756 7,026 7,307 7,600 8,622 8,967 9, ,460 6,246 6,496 6,756 7,026 7,307 8,290 8,622 8,967 9, ,006 6,246 6,496 6,756 7,026 7,972 8,290 8,622 8,967 9, ,006 6,246 6,496 6,756 7,665 7,972 8,290 8,622 8,967 10, ,006 6,246 6,496 7,370 7,665 7,972 8,290 8,622 9,714 10, ,006 6,246 7,087 7,370 7,665 7,972 8,290 9,340 9,714 10, ,006 6,814 7,087 7,370 7,665 7,972 8,981 9,340 9,714 10, ,552 6,814 7,087 7,370 7,665 8,636 8,981 9,340 9,714 10, ,552 6,814 7,087 7,370 8,304 8,636 8,981 9,340 9,714 10, ,552 6,814 7,087 7,984 8,304 8,636 8,981 9,340 10,461 10, ,552 6,814 7,677 7,984 8,304 8,636 8,981 10,059 10,461 10, ,552 7,382 7,677 7,984 8,304 8,636 9,672 10,059 10,461 10, ,098 7,382 7,677 7,984 8,304 9,300 9,672 10,059 10,461 10, ,098 7,382 7,677 7,984 8,942 9,300 9,672 10,059 10,461 11, ,098 7,382 7,677 8,598 8,942 9,300 9,672 10,059 11,209 11, ,098 7,382 8,268 8,598 8,942 9,300 9,672 10,777 11,209 11, ,098 7,950 8,268 8,598 8,942 9,300 10,363 10,777 11,209 11, ,644 7,950 8,268 8,598 8,942 9,964 10,363 10,777 11,209 11, ,644 7,950 8,268 8,598 9,581 9,964 10,363 10,777 11,209 12, ,644 7,950 8,268 9,213 9,581 9,964 10,363 10,777 11,956 12, ,644 7,950 8,858 9,213 9,581 9,964 10,363 11,496 11,956 12, ,644 8,518 8,858 9,213 9,581 9,964 11,054 11,496 11,956 12, ,190 8,518 8,858 9,213 9,581 10,629 11,054 11,496 11,956 12, ,190 8,518 8,858 9,213 10,220 10,629 11,054 11,496 11,956 12,434 This is a hypothetical example that illustrates values for a single annuitant. This example does not demonstrate an actual crediting scenario and is not a projection of the future results. Page 9

48 Cancellation You may cancel this rider at anytime. The rider will terminate when the annuity terminates for any reason or when the Maximum Guaranteed Annual Withdrawal Payment is less than $100. CONCLUSION Income Outlook Plus 5 from National Western Life provides the security of a guaranteed income stream you can not outlive in retirement. This rider also offers the opportunity for larger income benefits when indexed interest credits increase your annuity s Account Value. It also gives you control of your annuity as your needs change and access to your money if needed. About the Company National Western Life Insurance Company is a Colorado corporation with executive offices in Austin, Texas. The Company offers a full line of life insurance and annuity products (both on an individual and group basis), through independent agency offices in 49 states and the District of Columbia, and accepts applications from residents of several foreign countries. Visit our website at for all current financial information. Since its start in 1956, National Western has emphasized financial strength for the protection of its policyholders. As a legal reserve insurance company, National Western must set aside a portion of its assets equal to reserves required by law. Annually, a financial statement is filed with each state s insurance department. These departments have authority to verify that the appropriate reserves are maintained. Page 10

49 NATIONAL WESTERN LIFE INSURANCE COMPANY Income Outlook Plus 5 - Withdrawal Benefit Rider Thank you for choosing to add Income Outlook Plus 5 to your National Western Life indexed annuity. If you have any questions, please contact your agent or call National Western s Customer Service Department at We want to be sure that you read all 12 pages of this brochure and are aware of the benefits and features explained herein. Please initial and sign where indicated with an asterisk (*), acknowledging that you understand the following: T h i s is a withdrawal benefit rider that guarantees lifetime Withdrawal Payments after age 60. For purposes of this brochure, the assumption is that the Annuitant and Owner are the same. Once the Withdrawal Payments begin, there is no further Accumulation Period available. The full benefits of this rider are not obtained if the Withdrawal Payments are never taken. The Account Value of the policy is reduced each year by the Annual Rider Charge shown on page 1 of the rider, regardless of whether Withdrawal Payments are taken. If at the end of Accumulation Period you have not yet requested Withdrawal Payments or elected the Restart option, the Annual Rider Charge will continue to be deducted from the Account Value and the Accumulation Period Withdrawal Payment Base will no longer accumulate with interest. Any election to start or stop Withdrawal Payments must be received at National Western Life Insurance Company at least 20 days prior to the Policy Anniversary. * The above-stated features have been fully explained to me. I have received a copy of this brochure, and I have reviewed it with my agent. I fully understand the brochure and the specific points outlined above. The brochure is not a part of the rider and does not modify it in any way. The rider itself contains all terms, benefits, guarantees, limitations, restrictions, and exclusions. *Applicant s Signature Date I certify that I reviewed this brochure with the applicant Agent s Signature & Agent No. Date Applicant to Retain DM-1120-SIG.Rev.1.13 DM-1120-SIG.Rev.1.13 NATIONAL WESTERN LIFE INSURANCE COMPANY Income Outlook Plus 5 - Withdrawal Benefit Rider Thank you for choosing to add Income Outlook Plus 5 to your National Western Life indexed annuity. If you have any questions, please contact your agent or call National Western s Customer Service Department at We want to be sure that you read all 12 pages of this brochure and are aware of the benefits and features explained herein. Please initial and sign where indicated with an asterisk (*), acknowledging that you understand the following: T h i s is a withdrawal benefit rider that guarantees lifetime Withdrawal Payments after age 60. For purposes of this brochure, the assumption is that the Annuitant and Owner are the same. Once the Withdrawal Payments begin, there is no further Accumulation Period available. The full benefits of this rider are not obtained if the Withdrawal Payments are never taken. The Account Value of the policy is reduced each year by the Annual Rider Charge shown on page 1 of the rider, regardless of whether Withdrawal Payments are taken. If at the end of Accumulation Period you have not yet requested Withdrawal Payments or elected the Restart option, the Annual Rider Charge will continue to be deducted from the Account Value and the Accumulation Period Withdrawal Payment Base will no longer accumulate with interest. Any election to start or stop Withdrawal Payments must be received at National Western Life Insurance Company at least 20 days prior to the Policy Anniversary. * The above-stated features have been fully explained to me. I have received a copy of this brochure, and I have reviewed it with my agent. I fully understand the brochure and the specific points outlined above. The brochure is not a part of the rider and does not modify it in any way. The rider itself contains all terms, benefits, guarantees, limitations, restrictions, and exclusions. *Applicant s Signature Date I certify that I reviewed this brochure with the applicant Agent s Signature & Agent No. Date Submit with Application Page 11 Page 11

50 CLIENT SERVICES TOLL-FREE FAX CLIENT SERVICES TOLL-FREE FAX

51 ACCREDITED INVESTOR ACKNOWLEDGMENT FORM National Western Life Insurance Company is prohibited by Florida law from selling the annuity for which you have applied to any senior consumer (a purchaser 65 years of age or older) unless that senior consumer is an Accredited Investor. Florida law defines an Accredited Investor as any person who comes within any of the following categories at the time of the sale of an annuity to that person: 1. The person s net worth or joint net worth with his or her spouse, at the time of the purchase, exceeds $1 million; or 2. The person had an individual income in excess of $200,000 in each of the 2 most recent years, or joint income with his or her spouse in excess of $300,000 in each of those years, and has a reasonable expectation of reaching the same income level in the current year. Please note also that if a trust is the owner of the policy, Florida requires that in order to fall under the Accredited Investor exception, the trust must have assets in excess of $5 million, it must not have been formed to acquire the product for which it is applying, and its purchases must be made by a sophisticated person. If you are applying for this annuity, then you have represented to your agent, and to National Western, that you fall into at least one of the three above categories and are therefore eligible to purchase the annuity for which you have applied. Instructions: Please check any one or all of the small boxes below beside the statement that represents the category that qualifies you as an Accredited Investor and sign the certification below. My net worth or joint net worth with my spouse, at the time of this purchase, exceeds $1 million; or I had an individual income in excess of $200,000 in each of the 2 most recent years, or joint income with my spouse in excess of $300,000 in each of those years, and I have a reasonable expectation of reaching the same income level in the current year. A trust will be the owner of this policy and it has assets in excess of $5 million, was not formed to acquire the product for which it is applying, and its purchases are made by a sophisticated person. By signing below, I certify that I have read the above information and that I am an Accredited Investor as defined by Florida law. I realize that National Western is issuing this annuity in reliance on my representation. Signature: Date: Printed Name: DM-1171

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53 Deferred Annuity Certifications It is the policy of National Western Life Insurance Company (the Company) not to issue a deferred annuity if the owner, applicant, trustee, or annuitant is in a Nursing Home Facility or has a mental impairment/medical condition as described below. As a result, the Company requires certifications of the named individuals in order to ensure that this policy is enforced and is relying on these certifications in its decision to issue the deferred annuity for which application is being made. Please note that if you are signing on behalf of any of the named individuals (for example, you hold a Power of Attorney, etc.), then the certification pertains to that individual, not to you. A Nursing Home Facility is a facility that meets all of the following criteria: 1. It is licensed as a nursing home by the state where it is located; and 2. It is a separate facility or a distinct part of another facility physically separated from the rest of such facility; and 3. It provides nursing care to individuals who are not able to fully care for themselves and/or who require confinement; and 4. Its primary function is to provide continuous 24 hour-a-day nursing care, room, and board, and it charges for these services. The care must be performed under the direction of a Physician or a registered nurse (RN) or a licensed practical nurse (LPN). Annuitant Certification I certify all of the following to be true, with respect to the Annuitant, by signature below: I currently do not reside in a Nursing Home Facility and do not plan to enter a Nursing Home Facility in the next 6 months. I have never been diagnosed with, treated for, or consulted with a medical or healthcare advisor for mental deterioration due to an organic brain disorder such as dementia, Alzheimer s disease, or brain injury. I have never been medically diagnosed as having a terminal illness or life expectancy of 12 months or less. Annuitant Signature Date Owner/Applicant/Trustee Certification (if other than annuitant, complete this section) I certify all of the following to be true by signature below: I currently do not (or the trust beneficiary/grantor/settlor if a trust is the owner) reside in a Nursing Home Facility and do not plan to enter a Nursing Home Facility in the next 6 months. I have never been diagnosed with, treated for, or consulted with a medical or healthcare advisor for mental deterioration due to an organic brain disorder such as dementia, Alzheimer s disease, or brain injury. I have never been medically diagnosed as having a terminal illness or life expectancy of 12 months or less. Owner/Applicant/Trustee Signature Joint Owner/Applicant/Co-Trustee Signature (if applicable) Date Date Agent Certification By signing below, I certify that I have no reasonable grounds to believe that the foregoing certifications are false. Agent Signature Agent Number Date DM-1243.Rev.9.12

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55 Comparative Information Form For Proposed Insurance Name of Proposed Insured Birth Date Age Address Telephone Name of NWL Agent Policy Information Existing Insurance Proposed Insurance Name & Address of Company Policy Generic Name Policy Number Date of Issue/Issue Age Contestable Period Expires Suicide Period Expires Policy Loan Rates Composite Disclosure of Existing Insurance for Primary Insured Year Age Annual Premium Guarantees Cumulative Premium Cash Value Death Benefit Annual Benefit Projections* Cumulative Premium Cash Value Death Benefit Current 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th 13th 14th 15th 16th 17th 18th 19th 20th * Projections include dividends and current interest rates which are not guaranteed. IMPORTANT NOTICE: The income tax treatment of the benefits illustrated above may significantly affect their magnitude. Competent tax advice should be secured to clarify income tax implications. NATIONAL WESTERN LIFE INSURANCE COMPANY Copy Applicant s /Insured s Original Home Office SA 5910 FL.Rev EAST ANDERSON LANE AUSTIN, TEXAS Page 1 of 3

56 (CONTINUED) Name of Proposed Insured Name of NWL Agent Policy Information Existing Insurance Proposed Insurance Policy/Rider Name Initial/Continuing Benefit (Age) Benefit From: To: From: To: Initial/Renewal Annual Premium (Age) Payable From: To: From: To: Total Initial Annual Premium $ Mode Amt $ $ Mode Amt $ Total Renewal Annual Premium $ Amt $ $ Amt $ Composite Disclosure of Existing Insurance for Primary Insured Year Age Annual Premium Guarantees Cumulative Premium Cash Value Death Benefit Annual Benefit Projections* Cumulative Premium Cash Value Death Benefit Current 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th 13th 14th 15th 16th 17th 18th 19th 20th * Projections include dividends and current interest rates which are not guaranteed. IMPORTANT NOTICE: The income tax treatment of the benefits illustrated above may significantly affect their magnitude. Competent tax advice should be secured to clarify income tax implications. SA 5910 FL.Rev.6.16 NATIONAL WESTERN LIFE INSURANCE COMPANY 850 EAST ANDERSON LANE AUSTIN, TEXAS Copy Applicant s /Insured s Original Home Office Page 2 of 3

57 INSTRUCTIONAL NOTES FOR COMPLETION OF COMPARATIVE INFORMATION FORM 1. Existing life insurance must be identified by name of insurer and the policy number. In the event that a policy number has not been assigned by the existing insurer, an alternative identification form such as an application or receipt number must be shown. 2. If more than one existing life insurance policy is to be replaced, a separate Comparative Information Form is to be provided for each such policy. 3. In the disclosure of values premiums shall be shown only if they increase the cash value or death benefits for the primary insured. 4. Any benefits for secondary insureds shall be shown on a supplementary exhibit. 5. Values will be shown for each year in which either an initial change in face value or premium payment occurs. 6. Values will be shown in the disclosure for the maximum duration policy guarantees permit. If this benefit extension requires that guaranteed policy options be utilized, the option to be used will be that (those) automatically utilized by the issuing insurer. However, if the policy application provides for applicant election, then the extension of benefits will employ the optionactually elected by the applicant. Any option utilized for extension of benefits must be identified and briefly explained in the Policy/Rider Description section of the Comparative Information Form. 7. The dividend option elected-by an insured or applicant must be identified and briefly explained in the Policy/Rider Description section of the Comparative Information Form. The dividend option elected by the insured or applicant must be employed in completing the disclosure of values. SA 5910 FL.Rev.6.16 NATIONAL WESTERN LIFE INSURANCE COMPANY 850 EAST ANDERSON LANE AUSTIN, TEXAS Copy Applicant s /Insured s Original Home Office Page 3 of 3

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59 NOTICE TO APPLICANT REGARDING REPLACEMENT OF LIFE INSURANCE A decision to buy a new policy and discontinue or change an existing policy may be a wise choice or a mistake. Get all of the facts. Make sure you fully understand both the proposed policy and your existing policy or policies. New policies may contain clauses which limit or exclude coverage of certain events in the initial period of the contract, such as the suicide and incontestable clauses which may have already been satisfied in your existing policy or policies. Your best source for facts on the proposed policy is the proposed company and its agent. The best source on your existing policy is the existing company and its agent. Hear from both before you make your decision. This way you can be sure your decision is in your best interest. If you indicate that you intend to replace or change an existing policy, Florida regulations require notification of the company that issued the policy. Florida regulations give you the right to receive a written Comparative Information Form which summarizes your policy values. Indicate whether or not you wish to receive a Comparative Information Form from the proposed company and your existing insurer or insurers by placing your initials in the appropriate box below. Yes No Do not take action to terminate your existing policy until your new policy has been issued and you have examined it and found it acceptable. I have read this notice and received a copy of it. Applicant s Signature Agent s Signature Agent s Name (Printed or Typed) Agent s Address (Printed or Typed) Date Date Agent s License Number Agent s Company (Printed or Typed) Information on policies which may be replaced: Company Name Policy Number Name of Insured SA 5915 FL.Rev.6.12 NATIONAL WESTERN LIFE INSURANCE COMPANY 850 EAST ANDERSON LANE AUSTIN, TEXAS White Applicant Yellow Existing Insurer Pink Home Office

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61 Form W-9 (Rev. December 2014) Department of the Treasury Internal Revenue Service Request for Taxpayer Identification Number and Certification 1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank. Give Form to the requester. Do not send to the IRS. Print or type See Specific Instructions on page 2. 2 Business name/disregarded entity name, if different from above 3 Check appropriate box for federal tax classification; check only one of the following seven boxes: Individual/sole proprietor or single-member LLC C Corporation S Corporation Partnership Trust/estate Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=partnership) Note. For a single-member LLC that is disregarded, do not check LLC; check the appropriate box in the line above for the tax classification of the single-member owner. Other (see instructions) 5 Address (number, street, and apt. or suite no.) 6 City, state, and ZIP code 4 Exemptions (codes apply only to certain entities, not individuals; see instructions on page 3): Exempt payee code (if any) Exemption from FATCA reporting code (if any) (Applies to accounts maintained outside the U.S.) Requester s name and address (optional) 7 List account number(s) here (optional) Part I Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. Note. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 for guidelines on whose number to enter. Social security number or Employer identification number Part II Certification Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. I am a U.S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions on page 3. Sign Here Signature of U.S. person General Instructions Section references are to the Internal Revenue Code unless otherwise noted. Future developments. Information about developments affecting Form W-9 (such as legislation enacted after we release it) is at Purpose of Form An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return. Examples of information returns include, but are not limited to, the following: Form 1099-INT (interest earned or paid) Form 1099-DIV (dividends, including those from stocks or mutual funds) Form 1099-MISC (various types of income, prizes, awards, or gross proceeds) Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) Form 1099-S (proceeds from real estate transactions) Form 1099-K (merchant card and third party network transactions) Date Form 1098 (home mortgage interest), 1098-E (student loan interest), 1098-T (tuition) Form 1099-C (canceled debt) Form 1099-A (acquisition or abandonment of secured property) Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN. If you do not return Form W-9 to the requester with a TIN, you might be subject to backup withholding. See What is backup withholding? on page 2. By signing the filled-out form, you: 1. Certify that the TIN you are giving is correct (or you are waiting for a number to be issued), 2. Certify that you are not subject to backup withholding, or 3. Claim exemption from backup withholding if you are a U.S. exempt payee. If applicable, you are also certifying that as a U.S. person, your allocable share of any partnership income from a U.S. trade or business is not subject to the withholding tax on foreign partners' share of effectively connected income, and 4. Certify that FATCA code(s) entered on this form (if any) indicating that you are exempt from the FATCA reporting, is correct. See What is FATCA reporting? on page 2 for further information. SA-8505.Rev.1.15 Cat. No X Form W-9 (Rev )

62 Form W-9 (Rev ) Page 2 Note. If you are a U.S. person and a requester gives you a form other than Form W-9 to request your TIN, you must use the requester s form if it is substantially similar to this Form W-9. Definition of a U.S. person. For federal tax purposes, you are considered a U.S. person if you are: An individual who is a U.S. citizen or U.S. resident alien; A partnership, corporation, company, or association created or organized in the United States or under the laws of the United States; An estate (other than a foreign estate); or A domestic trust (as defined in Regulations section ). Special rules for partnerships. Partnerships that conduct a trade or business in the United States are generally required to pay a withholding tax under section 1446 on any foreign partners share of effectively connected taxable income from such business. Further, in certain cases where a Form W-9 has not been received, the rules under section 1446 require a partnership to presume that a partner is a foreign person, and pay the section 1446 withholding tax. Therefore, if you are a U.S. person that is a partner in a partnership conducting a trade or business in the United States, provide Form W-9 to the partnership to establish your U.S. status and avoid section 1446 withholding on your share of partnership income. In the cases below, the following person must give Form W-9 to the partnership for purposes of establishing its U.S. status and avoiding withholding on its allocable share of net income from the partnership conducting a trade or business in the United States: In the case of a disregarded entity with a U.S. owner, the U.S. owner of the disregarded entity and not the entity; In the case of a grantor trust with a U.S. grantor or other U.S. owner, generally, the U.S. grantor or other U.S. owner of the grantor trust and not the trust; and In the case of a U.S. trust (other than a grantor trust), the U.S. trust (other than a grantor trust) and not the beneficiaries of the trust. Foreign person. If you are a foreign person or the U.S. branch of a foreign bank that has elected to be treated as a U.S. person, do not use Form W-9. Instead, use the appropriate Form W-8 or Form 8233 (see Publication 515, Withholding of Tax on Nonresident Aliens and Foreign Entities). Nonresident alien who becomes a resident alien. Generally, only a nonresident alien individual may use the terms of a tax treaty to reduce or eliminate U.S. tax on certain types of income. However, most tax treaties contain a provision known as a saving clause. Exceptions specified in the saving clause may permit an exemption from tax to continue for certain types of income even after the payee has otherwise become a U.S. resident alien for tax purposes. If you are a U.S. resident alien who is relying on an exception contained in the saving clause of a tax treaty to claim an exemption from U.S. tax on certain types of income, you must attach a statement to Form W-9 that specifies the following five items: 1. The treaty country. Generally, this must be the same treaty under which you claimed exemption from tax as a nonresident alien. 2. The treaty article addressing the income. 3. The article number (or location) in the tax treaty that contains the saving clause and its exceptions. 4. The type and amount of income that qualifies for the exemption from tax. 5. Sufficient facts to justify the exemption from tax under the terms of the treaty article. Example. Article 20 of the U.S.-China income tax treaty allows an exemption from tax for scholarship income received by a Chinese student temporarily present in the United States. Under U.S. law, this student will become a resident alien for tax purposes if his or her stay in the United States exceeds 5 calendar years. However, paragraph 2 of the first Protocol to the U.S.-China treaty (dated April 30, 1984) allows the provisions of Article 20 to continue to apply even after the Chinese student becomes a resident alien of the United States. A Chinese student who qualifies for this exception (under paragraph 2 of the first protocol) and is relying on this exception to claim an exemption from tax on his or her scholarship or fellowship income would attach to Form W-9 a statement that includes the information described above to support that exemption. If you are a nonresident alien or a foreign entity, give the requester the appropriate completed Form W-8 or Form Backup Withholding What is backup withholding? Persons making certain payments to you must under certain conditions withhold and pay to the IRS 28% of such payments. This is called backup withholding. Payments that may be subject to backup withholding include interest, tax-exempt interest, dividends, broker and barter exchange transactions, rents, royalties, nonemployee pay, payments made in settlement of payment card and third party network transactions, and certain payments from fishing boat operators. Real estate transactions are not subject to backup withholding. You will not be subject to backup withholding on payments you receive if you give the requester your correct TIN, make the proper certifications, and report all your taxable interest and dividends on your tax return. Payments you receive will be subject to backup withholding if: 1. You do not furnish your TIN to the requester, 2. You do not certify your TIN when required (see the Part II instructions on page 3 for details), 3. The IRS tells the requester that you furnished an incorrect TIN, 4. The IRS tells you that you are subject to backup withholding because you did not report all your interest and dividends on your tax return (for reportable interest and dividends only), or 5. You do not certify to the requester that you are not subject to backup withholding under 4 above (for reportable interest and dividend accounts opened after 1983 only). Certain payees and payments are exempt from backup withholding. See Exempt payee code on page 3 and the separate Instructions for the Requester of Form W-9 for more information. Also see Special rules for partnerships above. What is FATCA reporting? The Foreign Account Tax Compliance Act (FATCA) requires a participating foreign financial institution to report all United States account holders that are specified United States persons. Certain payees are exempt from FATCA reporting. See Exemption from FATCA reporting code on page 3 and the Instructions for the Requester of Form W-9 for more information. Updating Your Information You must provide updated information to any person to whom you claimed to be an exempt payee if you are no longer an exempt payee and anticipate receiving reportable payments in the future from this person. For example, you may need to provide updated information if you are a C corporation that elects to be an S corporation, or if you no longer are tax exempt. In addition, you must furnish a new Form W-9 if the name or TIN changes for the account; for example, if the grantor of a grantor trust dies. Penalties Failure to furnish TIN. If you fail to furnish your correct TIN to a requester, you are subject to a penalty of $50 for each such failure unless your failure is due to reasonable cause and not to willful neglect. Civil penalty for false information with respect to withholding. If you make a false statement with no reasonable basis that results in no backup withholding, you are subject to a $500 penalty. Criminal penalty for falsifying information. Willfully falsifying certifications or affirmations may subject you to criminal penalties including fines and/or imprisonment. Misuse of TINs. If the requester discloses or uses TINs in violation of federal law, the requester may be subject to civil and criminal penalties. Specific Instructions Line 1 You must enter one of the following on this line; do not leave this line blank. The name should match the name on your tax return. If this Form W-9 is for a joint account, list first, and then circle, the name of the person or entity whose number you entered in Part I of Form W-9. a. Individual. Generally, enter the name shown on your tax return. If you have changed your last name without informing the Social Security Administration (SSA) of the name change, enter your first name, the last name as shown on your social security card, and your new last name. Note. ITIN applicant: Enter your individual name as it was entered on your Form W-7 application, line 1a. This should also be the same as the name you entered on the Form 1040/1040A/1040EZ you filed with your application. b. Sole proprietor or single-member LLC. Enter your individual name as shown on your 1040/1040A/1040EZ on line 1. You may enter your business, trade, or doing business as (DBA) name on line 2. c. Partnership, LLC that is not a single-member LLC, C Corporation, or S Corporation. Enter the entity's name as shown on the entity's tax return on line 1 and any business, trade, or DBA name on line 2. d. Other entities. Enter your name as shown on required U.S. federal tax documents on line 1. This name should match the name shown on the charter or other legal document creating the entity. You may enter any business, trade, or DBA name on line 2. e. Disregarded entity. For U.S. federal tax purposes, an entity that is disregarded as an entity separate from its owner is treated as a disregarded entity. See Regulations section (c)(2)(iii). Enter the owner's name on line 1. The name of the entity entered on line 1 should never be a disregarded entity. The name on line 1 should be the name shown on the income tax return on which the income should be reported. For example, if a foreign LLC that is treated as a disregarded entity for U.S. federal tax purposes has a single owner that is a U.S. person, the U.S. owner's name is required to be provided on line 1. If the direct owner of the entity is also a disregarded entity, enter the first owner that is not disregarded for federal tax purposes. Enter the disregarded entity's name on line 2, Business name/disregarded entity name. If the owner of the disregarded entity is a foreign person, the owner must complete an appropriate Form W-8 instead of a Form W-9. This is the case even if the foreign person has a U.S. TIN.

63 Form W-9 (Rev ) Page 3 Line 2 If you have a business name, trade name, DBA name, or disregarded entity name, you may enter it on line 2. Line 3 Check the appropriate box in line 3 for the U.S. federal tax classification of the person whose name is entered on line 1. Check only one box in line 3. Limited Liability Company (LLC). If the name on line 1 is an LLC treated as a partnership for U.S. federal tax purposes, check the Limited Liability Company box and enter P in the space provided. If the LLC has filed Form 8832 or 2553 to be taxed as a corporation, check the Limited Liability Company box and in the space provided enter C for C corporation or S for S corporation. If it is a single-member LLC that is a disregarded entity, do not check the Limited Liability Company box; instead check the first box in line 3 Individual/sole proprietor or single-member LLC. Line 4, Exemptions If you are exempt from backup withholding and/or FATCA reporting, enter in the appropriate space in line 4 any code(s) that may apply to you. Exempt payee code. Generally, individuals (including sole proprietors) are not exempt from backup withholding. Except as provided below, corporations are exempt from backup withholding for certain payments, including interest and dividends. Corporations are not exempt from backup withholding for payments made in settlement of payment card or third party network transactions. Corporations are not exempt from backup withholding with respect to attorneys' fees or gross proceeds paid to attorneys, and corporations that provide medical or health care services are not exempt with respect to payments reportable on Form 1099-MISC. The following codes identify payees that are exempt from backup withholding. Enter the appropriate code in the space in line 4. 1 An organization exempt from tax under section 501(a), any IRA, or a custodial account under section 403(b)(7) if the account satisfies the requirements of section 401(f)(2) 2 The United States or any of its agencies or instrumentalities 3 A state, the District of Columbia, a U.S. commonwealth or possession, or any of their political subdivisions or instrumentalities 4 A foreign government or any of its political subdivisions, agencies, or instrumentalities 5 A corporation 6 A dealer in securities or commodities required to register in the United States, the District of Columbia, or a U.S. commonwealth or possession 7 A futures commission merchant registered with the Commodity Futures Trading Commission 8 A real estate investment trust 9 An entity registered at all times during the tax year under the Investment Company Act of A common trust fund operated by a bank under section 584(a) 11 A financial institution 12 A middleman known in the investment community as a nominee or custodian 13 A trust exempt from tax under section 664 or described in section 4947 The following chart shows types of payments that may be exempt from backup withholding. The chart applies to the exempt payees listed above, 1 through 13. IF the payment is for... THEN the payment is exempt for... Interest and dividend payments All exempt payees except for 7 Broker transactions Exempt payees 1 through 4 and 6 through 11 and all C corporations. S corporations must not enter an exempt payee code because they are exempt only for sales of noncovered securities acquired prior to Barter exchange transactions and patronage dividends Payments over $600 required to be reported and direct sales over $5,000 1 Payments made in settlement of payment card or third party network transactions Exempt payees 1 through 4 Generally, exempt payees 1 through 5 2 Exempt payees 1 through 4 1 See Form 1099-MISC, Miscellaneous Income, and its instructions. 2 However, the following payments made to a corporation and reportable on Form 1099-MISC are not exempt from backup withholding: medical and health care payments, attorneys' fees, gross proceeds paid to an attorney reportable under section 6045(f), and payments for services paid by a federal executive agency. Exemption from FATCA reporting code. The following codes identify payees that are exempt from reporting under FATCA. These codes apply to persons submitting this form for accounts maintained outside of the United States by certain foreign financial institutions. Therefore, if you are only submitting this form for an account you hold in the United States, you may leave this field blank. Consult with the person requesting this form if you are uncertain if the financial institution is subject to these requirements. A requester may indicate that a code is not required by providing you with a Form W-9 with Not Applicable (or any similar indication) written or printed on the line for a FATCA exemption code. A An organization exempt from tax under section 501(a) or any individual retirement plan as defined in section 7701(a)(37) B The United States or any of its agencies or instrumentalities C A state, the District of Columbia, a U.S. commonwealth or possession, or any of their political subdivisions or instrumentalities D A corporation the stock of which is regularly traded on one or more established securities markets, as described in Regulations section (c)(1)(i) E A corporation that is a member of the same expanded affiliated group as a corporation described in Regulations section (c)(1)(i) F A dealer in securities, commodities, or derivative financial instruments (including notional principal contracts, futures, forwards, and options) that is registered as such under the laws of the United States or any state G A real estate investment trust H A regulated investment company as defined in section 851 or an entity registered at all times during the tax year under the Investment Company Act of 1940 I A common trust fund as defined in section 584(a) J A bank as defined in section 581 K A broker L A trust exempt from tax under section 664 or described in section 4947(a)(1) M A tax exempt trust under a section 403(b) plan or section 457(g) plan Note. You may wish to consult with the financial institution requesting this form to determine whether the FATCA code and/or exempt payee code should be completed. Line 5 Enter your address (number, street, and apartment or suite number). This is where the requester of this Form W-9 will mail your information returns. Line 6 Enter your city, state, and ZIP code. Part I. Taxpayer Identification Number (TIN) Enter your TIN in the appropriate box. If you are a resident alien and you do not have and are not eligible to get an SSN, your TIN is your IRS individual taxpayer identification number (ITIN). Enter it in the social security number box. If you do not have an ITIN, see How to get a TIN below. If you are a sole proprietor and you have an EIN, you may enter either your SSN or EIN. However, the IRS prefers that you use your SSN. If you are a single-member LLC that is disregarded as an entity separate from its owner (see Limited Liability Company (LLC) on this page), enter the owner s SSN (or EIN, if the owner has one). Do not enter the disregarded entity s EIN. If the LLC is classified as a corporation or partnership, enter the entity s EIN. Note. See the chart on page 4 for further clarification of name and TIN combinations. How to get a TIN. If you do not have a TIN, apply for one immediately. To apply for an SSN, get Form SS-5, Application for a Social Security Card, from your local SSA office or get this form online at You may also get this form by calling Use Form W-7, Application for IRS Individual Taxpayer Identification Number, to apply for an ITIN, or Form SS-4, Application for Employer Identification Number, to apply for an EIN. You can apply for an EIN online by accessing the IRS website at and clicking on Employer Identification Number (EIN) under Starting a Business. You can get Forms W-7 and SS-4 from the IRS by visiting IRS.gov or by calling TAX-FORM ( ). If you are asked to complete Form W-9 but do not have a TIN, apply for a TIN and write Applied For in the space for the TIN, sign and date the form, and give it to the requester. For interest and dividend payments, and certain payments made with respect to readily tradable instruments, generally you will have 60 days to get a TIN and give it to the requester before you are subject to backup withholding on payments. The 60-day rule does not apply to other types of payments. You will be subject to backup withholding on all such payments until you provide your TIN to the requester. Note. Entering Applied For means that you have already applied for a TIN or that you intend to apply for one soon. Caution: A disregarded U.S. entity that has a foreign owner must use the appropriate Form W-8.

64 Form W-9 (Rev ) Page 4 Part II. Certification To establish to the withholding agent that you are a U.S. person, or resident alien, sign Form W-9. You may be requested to sign by the withholding agent even if items 1, 4, or 5 below indicate otherwise. For a joint account, only the person whose TIN is shown in Part I should sign (when required). In the case of a disregarded entity, the person identified on line 1 must sign. Exempt payees, see Exempt payee code earlier. Signature requirements. Complete the certification as indicated in items 1 through 5 below. 1. Interest, dividend, and barter exchange accounts opened before 1984 and broker accounts considered active during You must give your correct TIN, but you do not have to sign the certification. 2. Interest, dividend, broker, and barter exchange accounts opened after 1983 and broker accounts considered inactive during You must sign the certification or backup withholding will apply. If you are subject to backup withholding and you are merely providing your correct TIN to the requester, you must cross out item 2 in the certification before signing the form. 3. Real estate transactions. You must sign the certification. You may cross out item 2 of the certification. 4. Other payments. You must give your correct TIN, but you do not have to sign the certification unless you have been notified that you have previously given an incorrect TIN. Other payments include payments made in the course of the requester s trade or business for rents, royalties, goods (other than bills for merchandise), medical and health care services (including payments to corporations), payments to a nonemployee for services, payments made in settlement of payment card and third party network transactions, payments to certain fishing boat crew members and fishermen, and gross proceeds paid to attorneys (including payments to corporations). 5. Mortgage interest paid by you, acquisition or abandonment of secured property, cancellation of debt, qualified tuition program payments (under section 529), IRA, Coverdell ESA, Archer MSA or HSA contributions or distributions, and pension distributions. You must give your correct TIN, but you do not have to sign the certification. What Name and Number To Give the Requester For this type of account: Give name and SSN of: 1. Individual The individual 2. Two or more individuals (joint The actual owner of the account or, account) if combined funds, the first individual on the account 1 3. Custodian account of a minor The minor 2 (Uniform Gift to Minors Act) 4. a. The usual revocable savings The grantor-trustee 1 trust (grantor is also trustee) b. So-called trust account that is The actual owner 1 not a legal or valid trust under state law 5. Sole proprietorship or disregarded The owner 3 entity owned by an individual 6. Grantor trust filing under Optional The grantor* Form 1099 Filing Method 1 (see Regulations section (b)(2)(i) (A)) For this type of account: Give name and EIN of: 7. Disregarded entity not owned by an The owner individual 8. A valid trust, estate, or pension trust Legal entity 4 9. Corporation or LLC electing The corporation corporate status on Form 8832 or Form Association, club, religious, charitable, educational, or other taxexempt organization The organization 11. Partnership or multi-member LLC The partnership 12. A broker or registered nominee The broker or nominee 13. Account with the Department of The public entity Agriculture in the name of a public entity (such as a state or local government, school district, or prison) that receives agricultural program payments 14. Grantor trust filing under the Form The trust 1041 Filing Method or the Optional Form 1099 Filing Method 2 (see Regulations section (b)(2)(i) (B)) 1 List first and circle the name of the person whose number you furnish. If only one person on a joint account has an SSN, that person s number must be furnished. 2 Circle the minor s name and furnish the minor s SSN. 3 You must show your individual name and you may also enter your business or DBA name on the Business name/disregarded entity name line. You may use either your SSN or EIN (if you have one), but the IRS encourages you to use your SSN. 4 List first and circle the name of the trust, estate, or pension trust. (Do not furnish the TIN of the personal representative or trustee unless the legal entity itself is not designated in the account title.) Also see Special rules for partnerships on page 2. *Note. Grantor also must provide a Form W-9 to trustee of trust. Note. If no name is circled when more than one name is listed, the number will be considered to be that of the first name listed. Secure Your Tax Records from Identity Theft Identity theft occurs when someone uses your personal information such as your name, SSN, or other identifying information, without your permission, to commit fraud or other crimes. An identity thief may use your SSN to get a job or may file a tax return using your SSN to receive a refund. To reduce your risk: Protect your SSN, Ensure your employer is protecting your SSN, and Be careful when choosing a tax preparer. If your tax records are affected by identity theft and you receive a notice from the IRS, respond right away to the name and phone number printed on the IRS notice or letter. If your tax records are not currently affected by identity theft but you think you are at risk due to a lost or stolen purse or wallet, questionable credit card activity or credit report, contact the IRS Identity Theft Hotline at or submit Form For more information, see Publication 4535, Identity Theft Prevention and Victim Assistance. Victims of identity theft who are experiencing economic harm or a system problem, or are seeking help in resolving tax problems that have not been resolved through normal channels, may be eligible for Taxpayer Advocate Service (TAS) assistance. You can reach TAS by calling the TAS toll-free case intake line at or TTY/TDD Protect yourself from suspicious s or phishing schemes. Phishing is the creation and use of and websites designed to mimic legitimate business s and websites. The most common act is sending an to a user falsely claiming to be an established legitimate enterprise in an attempt to scam the user into surrendering private information that will be used for identity theft. The IRS does not initiate contacts with taxpayers via s. Also, the IRS does not request personal detailed information through or ask taxpayers for the PIN numbers, passwords, or similar secret access information for their credit card, bank, or other financial accounts. If you receive an unsolicited claiming to be from the IRS, forward this message to phishing@irs.gov. You may also report misuse of the IRS name, logo, or other IRS property to the Treasury Inspector General for Tax Administration (TIGTA) at You can forward suspicious s to the Federal Trade Commission at: spam@uce.gov or contact them at or IDTHEFT ( ). Visit IRS.gov to learn more about identity theft and how to reduce your risk. Privacy Act Notice Section 6109 of the Internal Revenue Code requires you to provide your correct TIN to persons (including federal agencies) who are required to file information returns with the IRS to report interest, dividends, or certain other income paid to you; mortgage interest you paid; the acquisition or abandonment of secured property; the cancellation of debt; or contributions you made to an IRA, Archer MSA, or HSA. The person collecting this form uses the information on the form to file information returns with the IRS, reporting the above information. Routine uses of this information include giving it to the Department of Justice for civil and criminal litigation and to cities, states, the District of Columbia, and U.S. commonwealths and possessions for use in administering their laws. The information also may be disclosed to other countries under a treaty, to federal and state agencies to enforce civil and criminal laws, or to federal law enforcement and intelligence agencies to combat terrorism. You must provide your TIN whether or not you are required to file a tax return. Under section 3406, payers must generally withhold a percentage of taxable interest, dividend, and certain other payments to a payee who does not give a TIN to the payer. Certain penalties may also apply for providing false or fraudulent information.

65 AUTHORIZATION TO TRANSFER/EXCHANGE FUNDS The form can be used to initiate an exchange of policies (full or partial) pursuant to Internal Revenue Code Section 1035 ( 1035 Exchange ). The form may also be used to conduct Qualified Transfers and Direct Rollovers. Please refer to the application and any other state required forms for specific disclosures and information. Please consult with the distributing company for any specific form requirements for the transaction being initiated. Once complete, please sign and date this form and return to your agent. Some transactions may require a medallion signature or signature of other third parties. PLEASE COMPLETE ONLY ONE FORM FOR EACH DISTRIBUTING COMPANY AND POLICY OR CONTRACT SECTION 1: NWL INFORMATION Existing Policy/Contract Number (if no number provided, funds will be applied to a new account.) Owner Information Annuitant or Proposed Insured 1) Owner Name: 2) Annuitant/Proposed Insured Name: 1a) SSN/Tax ID: 2a) SSN/Tax ID: 3) Joint Owner Name: 4) Joint/Co-Annuitant or 3a) SSN/Tax ID: Proposed Insured Name: 4a) SSN/Tax ID: SECTION 2: DISTRIBUTING COMPANY Note: This form may not be accepted by a 401k or other employer-sponsored retirement plans. The applicant may need to complete a phone liquidation/transfer or other plan-specific paperwork. 5) Policy/Contract Owner(s) Name(s) 6) Distributing Company Name 7) Distributing Company Policy/Contract Number 8) Distributing Company Overnight Address 9) City 10) State 11) Zip (P.O. Box addresses are not accepted) 12) Distributing Company Phone Number 13) Distributing Company Fax Number SECTION 3: EXISTING ACCOUNT INFORMATION 14) Account Type: Annuity (Attach account statement within last 12 months) Life Policy (Attach account statement within last 12 months) Mutual Funds/Stocks/Bonds Certificate of Deposit (CD)* Brokerage Account Number(s) (If not a full liquidation, specify accounts to be liquidated) Money Market Other (Specify) *The CD maturity date must occur within 60 days of transfer. To specify liquidation date, please refer to section 5. Liquidations prior to maturity may incur a penalty. SECTION 4: TRANSACTION INSTRUCTION PLEASE complete only ONE of the following sections: Qualified Funds Transfer or Rollover (15), Non-Qualified 1035 Exchange (16), or Non-Qualified Transfer (17) 15) Qualified Funds Transfer or Rollover 15a) Full Transfer or Rollover, or Partial Transfer or Rollover: Penalty Free Withdrawal, or Transfer Amount: $ or % 15b) Existing Qualified Funds Transfer or Rollover FROM: 15c) Existing Qualified Funds Transfer or Rollover TO: Traditional IRA Inherited/Beneficiary IRA Traditional IRA Inherited/Beneficiary IRA Roth IRA Other (Specify) Roth IRA (please attach death certificate) SEP IRA Employer-Sponsored Plan* SEP IRA Other (Specify) *Employer-Sponsored Retirement Plans Only 401(k) 401(a) 403(b)/TSA/457 Qualifying Event Age 59½ Separated from service (Date / / ) Other: SA-8600.Rev d) If Owner is age 70½ or older, please mark one: Send policyholder the RMD amount for the current tax year prior to processing this transaction. Policyholder will (or already has) satisfied current year RMD. Page 1 of 2

66 16) Non-Qualified 1035 Exchange (life insurance policy or annuity contract) Please check only ONE. Full Exchange, or Partial Exchange (check only one below) Penalty Free Exchange, or Exchange Amount: $ or % AUTHORIZATION TO PERFORM 1035 EXCHANGE By signing below, Owner assigns and transfers to NWL all rights, title, interest, options, and privileges to the life insurance policy, annuity contract, or part of the annuity contract or life policy identified in Section 2, as specified by this form. The Owner represents that he/she is executing this assignment solely to effect a 1035 Exchange, and acknowledges that NWL intends to surrender the policy or contract for its cash value or, if this is a partial surrender, then for the portion assigned subject to the contract s terms and conditions. By signing below, the Owner directs that the distributing company send the proceeds directly to National Western, and that National Western use the surrendered proceeds as purchase payment for a contract or policy issued by National Western. The Owner acknowledges that fees and charges may apply as a result of this surrender. 17) Non-Qualified Transfer (NOT for 1035 Exchange) Please check only ONE. Full Non-Qualified Transfer (NOT for 1035 Exchange) Partial Non-Qualified Transfer (NOT for 1035 Exchange) $ or % AUTHORIZATION TO LIQUIDATE AND TRANSFER By signing below, Owner directs that the Distributing Company liquidate and transfer the full value or the partial value of the Distributing Company account identified in Section 2. The Owner further directs National Western apply all such funds received to an annuity or life contract issued to Owner. The Owner further acknowledges and accepts responsibility for any charges or fees that may be imposed as a result of this liquidation. FEDERAL INCOME TAX WITHOLDING Notwithstanding the election made below, the Owner acknowledges that National Western assumes no responsibility for the tax treatment of this transaction, and that fees or charges may apply if the account is surrendered before the maturity date. In the event the payments of estimated tax payment and withholding, if any, are not adequate, any resulting tax penalties are the responsibility of the Owner. If no selection is made, NWL assumes no withholdings are required. Please withhold federal income tax from my surrender ($ or %) Do not withhold federal income tax. SECTION 5: TIMING AND ADDITIONAL REQUESTS By signing below, Owner authorizes full or partial liquidation of his/her funds: Immediately OR On a specific date / / If neither box is checked, transaction is to be processed immediately. Additional Requests SECTION 6: ACKNOWLEDGEMENTS AND SIGNATURES RELEASE OF INFORMATION -- In addition to the authorization and acknowledgements provided above, the undersigned grants permission to release all information pertaining to this requested transaction to National Western Life Insurance Company as long as the transaction is pending. LOST POLICY/CONTRACT -- If the life insurance policy or annuity contract identified in Section 2 is not attached, the undersigned certifies that the contract or policy has been lost or destroyed, and to the best of their knowledge, is not in anyone's possession. Dated: this of, (City, State) (Day) (Month) (Year) Owner/Applicant/Trustee Signature Spouse/Domestic Partner Signature If you reside in one of the following states, Your spouse/domestic partner must also sign. (AZ, CA, ID, LA, NM, TX, WA, and WI) Joint Owner / Applicant / Trustee Signature Signature Guarantee (if applicable. Contact distributing company) National Western Life insurance Company 850 East Anderson Lane Austin, TX Phone Fax SA-8600.Rev.7.16 Page 2 of 2

67 MINIMUM DISTRIBUTION REQUIREMENTS DISCLOSURE For all annuitants age 70 and older Dear Annuity Contract Owner: We want to be sure you are aware of the Internal Revenue Code Regulation Section 1.401(a)(9), minimum distribution requirements that may affect your annuity contract. Please read this form carefully, sign, and send a copy with your application. If you attain(ed) age during the current calendar year and have a qualified retirement plan or IRA, the Internal Revenue Code normally requires that you take your first distribution between January 1 of this year and April 1 of the next calendar year (a later date may apply for governmental or church plans). Subsequent annual distributions are required to be taken no later than December 31 of each year, which means that your second minimum distribution must be taken no later than December 31 of the year following the year in which you attain age If you attained age prior to the current calendar year and have a qualified retirement plan or IRA, your minimum distribution must be taken no later than December 31 of this year. Depending upon your personal tax situation, it may be necessary for you to begin taking the required minimum distribution from your annuity contract. If this is the case, your agent can furnish the forms necessary to set up your minimum distribution. Please be aware that once you begin taking this distribution, you cannot change your selection. You should be aware that your annuity may have surrender charges or market value adjustments which will apply to your required minimum distribution. Additionally, you may not be permitted by certain annuity contracts to take any withdrawals without incurring a withdrawal charge during the first policy year. AS WITH ALL PERSONAL TAX MATTERS, WE STRONGLY SUGGEST THAT YOU CONSULT YOUR TAX ADVISOR BEFORE MAKING A DECISION ABOUT YOUR MINIMUM DISTRIBUTION. If you fail to take the required distribution by the appropriate deadline, you may be subject to an excise tax equal to 50% of the amount which should have been withdrawn but was not. Remember, unless you elect a minimum distribution, we must assume that you have met your minimum distribution requirements for this year and do not wish to elect to set up automatic distributions. National Western Life Insurance Company does not provide tax advice. If you have any tax questions, please consult with your tax advisor. I understand that it is my sole responsibility to comply with the Internal Revenue Code requirements concerning minimum distributions. Owner Date SA-8714.Rev.4.12 NATIONAL WESTERN LIFE INSURANCE COMPANY 850 EAST ANDERSON LANE AUSTIN, TEXAS

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69 POLICY DISCLOSURE AND INSTRUCTIONS FOR THE STATE OF FLORIDA National Western Life Insurance Company, 850 East Anderson Lane, Austin, Texas PLEASE READ CAREFULLY: This information has been prepared for you so that you may make an informed decision on the use of any of your policy values to fund the purchase of a new policy. Please see the reverse side of this form for explanatory notes and instructions as to how this form has been completed. PART A CURRENT POLICY INFORMATION r LIFE r ANNUITY Policyowner s Name Policy Number Current Death Benefit $ Current Premium Amount $ Mode of Payment Cash Surrender Value $ Paid-up Addition Value $ Dividend Value $ (The BENEFIT and VALUES stated above will be reduced as funds are used to purchase the policy proposed in Part B, below.) PART B PROPOSED POLICY INFORMATION r LIFE r ANNUITY Initial Death Benefit $ Proposed Premium Amount $ Mode of Payment Proposed Effective Date Premium Payable to Age or for Years NOTE: If you are replacing your current policy, or using 25% or more of your policy values, you may request a WRITTEN comparison between your current policy and the proposed policy. The comparison is to illustrate the policy values for both policies. PART C SOURCE OF FUNDING FOR PROPOSED POLICY A loan in the amount of $ will be taken from the value of your CURRENT POLICY each (mode), bearing a current loan interest rate of %. A partial surrender in the amount of $ will be taken from the value of your CURRENT POLICY each (mode). A dividend withdrawal in the amount of $ will be taken from the value of your CURRENT POLICY each (mode). PART D YOUR CURRENT POLICY COULD TERMINATE If the policy values of your CURRENT POLICY are used as a source of funding for the purchase of an additional policy, it is estimated that your CURRENT POLICY will terminate on (date). It is estimated that you will begin making premium payments for the PROPOSED POLICY from your own funds on (date) in the amount of $ to be paid each (mode). NOTE: Since the values and premiums stated on this form may change over time, the estimated date upon which you will need to begin making premium payments from your own funds for the PROPOSED POLICY may also change. Estimates as to dates when policies will terminate or payments must begin assume the continuation of current (or guaranteed) factors, and such calculations are based upon the assumption that any premiums or interest due on loans are paid when due. Policyowner Signature Date Agent or Company Officer Signature Date Florida License Agent Identification Number or Corporate Title (See Reverse Side for Instructions) SU-6512-FL.Rev.5.11 Original Company Copy Policyowner