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REGISTERED REPRESENTATIVE AND BROKER/DEALER CHANGE REQUEST CONTACT INFORMATION Pacific Life Insurance Company P.O. Box 2378 Omaha, NE 68103-2378 All Overnight Deliveries: 1299 Farnam Street, 6th Floor,.

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How to fill out the Guide09.indd. Forms - Fixed Annuity online

Filling out the Guide09.indd. Forms - Fixed Annuity online is a straightforward process that allows you to request changes related to registered representatives and broker/dealer information. This guide will walk you through each section and field of the form to ensure accurate completion.

Follow the steps to complete the form effectively.

  1. Click the ‘Get Form’ button to access the form and open it in your preferred editor.
  2. Begin with Section 1, titled 'Owner Information.' Fill in your name in the designated fields for First, Middle, and Last. Provide your daytime telephone number and the annuity contract number.
  3. Proceed to Section 2, titled 'New Registered Representative(s) Information.' Here, enter the broker/dealer's name, followed by details for up to two representatives. For each representative, provide their name, business street address, telephone number, and the percentage split if applicable.
  4. Move to Section 3, labeled 'Owner Authorization.' By signing in the designated place, you authorize Pacific Life to make the requested changes on your annuity contract(s). Make sure to include the date of your signature.
  5. If applicable, complete Section 4, titled 'Broker/Dealer Authorization.' An authorized officer, principal, or branch manager from the broker/dealer must provide their signature and title in the given space, including the date.
  6. Review all sections to ensure accuracy. Once you have completed the form, you can save your changes, download the form, print it, or share it as needed.

Complete your forms online today to ensure timely processing of your requests.

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