Follow the steps to successfully complete the form.

1. Click ‘Get Form’ button to obtain the Change Of Broker Dealer/Representative Authorization form and open it in your document editor.
2. In Section 1, enter your contract owner/annuitant account information. Provide your full name and the last four digits of your Social Security or Tax ID number. If applicable, include the name of any additional owner.
3. In Section 2, choose between Individual Reassignment and Block Reassignment. If you select Individual Reassignment, list all applicable account numbers. If Block Reassignment is chosen, it indicates that the entire book of business will be transferred. Include the company name and all necessary account numbers.
4. Fill out Section 3 with the previous broker dealer and representative information, including the broker dealer's name and the previous representative's full name.
5. In Section 4, provide the details of the new broker dealer and representative. Enter the broker dealer's name, address, and any applicable account number for linking purposes. If you are assigning a representative, include their name, Social Security number (last four digits), split percentage, contact details, and email address. You may also include additional representatives as needed.
6. Review Section 5 for financial professional authorization. Indicate whether you consent to the designated activities by checking ‘YES’ or ‘NO’ for each activity listed.
7. Complete Section 6 with custodial change information, including the custodian's name, contact information, and any instructions related to systematic withdrawals.
8. In Section 7, fill out the payment and mailing instructions. Provide the bank details if direct deposit is selected, ensuring to attach a voided check if necessary. Indicate whether the payment should be made to yourself or a special payee.
9. Finally, in Section 8, provide the necessary signatures for authorization. Ensure that you and any additional owners sign and date where indicated. If applicable, include signatures from custodial representatives.
10. Once you have filled out all sections of the form, save your changes, and you may choose to download, print, or share the form as necessary.

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