JACKSON NATIONAL LIFE INSURANCE COMPANY
8055 E. Tufts Avenue, 2nd Floor, P.O. Box 17240
Denver, CO 80217-0240
(800) 766-4683
Contract Owner Authorization for
Asset Allocation Service Provider and Fee Payment
Contract No.
In connection with withdrawals to pay Service Provider fees, the
Owner acknowledges the following:
This Agreement is among Jackson National Life Insurance Company
®
(“JNL
”), the owner (“Owner”) of the JNL variable annuity contract
1. The payment of such fees will be treated as a withdrawal under
referenced above (“Contract”), and the Asset Allocation Service
the terms of the Contract.
Provider who has signed below (“Service Provider”), and is effective
as of the date indicated below.
2. Withdrawals from the Contract for the payment of Service
Provider fees are subject to all contractual provisions applicable
Appointment and Transfer Authorization
to withdrawals from the Contract. Therefore, certain withdrawals
may be subject to minimum amounts, surrender penalties,
The Owner hereby appoints the Service Provider as the Owner’s true
recapture charges, and interest rate adjustments, and JNL may
and lawful attorney and agent to execute the transactions described
be required to liquidate a larger dollar amount than the amount
below with full power and authority to act in the Owner’s place and
required to pay the Service Provider’s fees. There are also tax
stead with the same effect as if the Owner had acted.
consequences as described below.
The Owner hereby authorizes any person at the Service Provider to:
All the parties agree that the Contract shall be solely liable for the
payment of the Service Provider’s fees and that those fees will not
1.
receive contract information;
be separately billed to nor paid by the Owner. Such fees shall only
be for investment advisory services related to the Contract.
2.
change the contract values between and among the investment
options of the Contract either by phone call to JNL or by
Federal Tax Status
inclusion on a written list transmitted by facsimile to JNL;
The Owner must elect the appropriate box below.
3.
change the future premium allocations between and among the
investment options of the Contract either by phone call to JNL or
Internal Revenue Code Section 408(a) or 403(b) or 408(b)
by inclusion on a written list transmitted by facsimile to JNL; and
Annuity:
The Owner declares that the Contract is solely
responsible for the Service Provider’s fees.
4.
make withdrawals from the Contract for the payment of asset
allocation service fees.
Nonqualified Annuity: The Owner declares that the Contract is
solely responsible for the Service Provider’s fees. The Owner
The Owner hereby authorizes JNL to release information regarding
acknowledges that under Federal tax law the payment of an
the Contract to the Service Provider and to comply with written,
investment advisor’s fees from a non-tax qualified annuity
telephone or faxed allocation and transfer instructions from the
contract will be treated as a taxable distribution and may also
Service Provider.
be subject to the 10% premature distribution penalty
applicable to withdrawals made prior to attaining age 59½.
The Owner understands that the Service Provider is subject to
conditions and limitations with transfer instructions in addition to the
The Owner has consulted with his or her own tax advisor
policies and procedures stated in the prospectus for the Contract,
regarding the tax treatment of the payment of the Advisor’s
including that premium and contract value may not be allocated to
fees from the Contract.
investment options investing in the JNL/S&P Managed Portfolios.
The Owner further understands that JNL, in its sole discretion, may
Withholding/Nonqualified Annuity
cease to honor and process any or all directions received from the
Service Provider if JNL deems a requested transaction to be
The taxable portion of the distribution(s) made under this Agreement
inconsistent with, or not in the best interest of, the variable annuity
will be subject to 10% federal income tax withholding unless you elect
contract, underlying funds, or JNL’s administrative rules and
not to have withholding apply. If you elect not to have withholding
procedures. But by honoring and processing the Service Provider’s
apply to your withdrawals, or if you do not have enough withheld, you
directions, the Owner understands that JNL is not providing
may be responsible for payment of estimated tax. You may incur
investment advice to the Owner.
penalties under the estimated tax rules if your withholding and
estimated tax payments are not sufficient. Depending on the laws of
your state, state income tax withholding may be required if
If the Owner is currently using any of JNL’s Dollar Cost Averaging or
Rebalancing
programs,
participation
in
an
asset
allocation
federal withholding is elected.
arrangement will, at JNL’s discretion, terminate the Owner’s
participation in these programs. In addition, the Owner understands
Federal Tax Withholding – The Owner must elect the appropriate
that asset allocation can alter the intended results of these programs.
box(es) below.
Payment of Fees
No, do not withhold federal income tax.
The Owner hereby authorizes JNL to act upon written instructions
Yes, withhold 10% federal income tax from each payment.
from the Service Provider to pay from the Owner’s Contract the
advisory fees charged by the Service Provider pursuant to a written
In addition to the 10% federal income tax withheld from each
advisory agreement between the Owner and the Service Provider.
payment, please withhold an additional percentage _______ %.
Checks for these fees will be made payable to the Service Provider.