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Guaranteed Accumulator MYGA

MYGA Annuity
Application

This guided interview collects everything needed for your Marquette Indemnity & Life Insurance Company single-premium deferred annuity application. At the end, your application is sent for secure e-signature — you'll be guided through the signing process and then returned to confirm.

Ownership & OwnerAnnuitant DetailsPlan SelectionBeneficiariesPremium & Tax StatusReplacementSuitabilityState FormsE-Signature

We currently offer annuities in Alabama, Arizona, Indiana, Louisiana, Mississippi, Missouri, Texas, Utah, and Puerto Rico.

Section 1 of 9

Ownership & Owner

Start with how the contract is owned. What we ask next depends on the ownership type, and we will confirm who the annuitant is at the end of this section.

Has the IRS notified you that you is currently subject to backup withholding for failing to report all interest or dividends?

The Annuitant

The annuitant is the person whose life the contract is based on.

Non-qualified contracts only. Uncommon, but supported.

Section 2 of 9

Annuitant Information

The annuitant is the person whose life the contract is based on. Enter their details below.

Section 3 of 9

Plan & Riders

Select your annuity product and any optional rider.

Section 4 of 9

Beneficiaries

Name primary and contingent beneficiaries. Percentages within each category must total 100%.
If joint owners are named, on the death of either joint owner, the surviving joint owner will become the sole primary beneficiary, and the beneficiaries listed below will be considered contingent beneficiaries.

Primary Beneficiaries

Primary Beneficiary 1
Primary Beneficiary 2 (optional)
Primary Beneficiary 3 (optional)
Primary Beneficiary 4 (optional)

Contingent Beneficiaries

Contingent Beneficiary 1
Contingent Beneficiary 2 (optional)
Contingent Beneficiary 3 (optional)
Contingent Beneficiary 4 (optional)
Section 5 of 9

Premium & Tax Status

Enter the premium amount and indicate the tax qualification status. If funds are coming via 1035 exchange, rollover, or direct transfer, a separate transfer form is also required.

The amount arriving by 1035 exchange, rollover or transfer. Entering one answers question 3 of the Replacement section.

EFT Bank Draft Authorization
Section 6 of 9

Replacement Questions

Required by state regulation. A "Yes" on question 2 means you must also submit a signed Replacement Form.

⚠ You must also sign and submit the Replacement Form with your application.

Section 7 of 9

Suitability Questionnaire

Marquette requires this information to confirm this annuity is suitable for your financial situation. All responses are confidential and submitted with your application.

Owner Financial Status
Investment Objectives
Financial Products & Funding
Declaration *
Buyer's Guide for Deferred Annuities
Section 8 of 9

State Forms

Section 9 of 9 — Final Step

You're almost done.

Great work — your application is complete.

Take a moment to review your information below. When everything looks right, check the confirmation box and click Review & Sign — you'll be guided through a secure signing page and returned here to confirm.

Any person who knowingly presents a false statement in an application for insurance may be guilty of a criminal offense. Annuities are not FDIC-insured or guaranteed by any government agency.

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Your application has been received.

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