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5 Fax: (877) 573-6177 EVIDENCE OF INSURABILITY INFORMATION Attach this form with your enrollment card and submit to The Lincoln National Life Insurance Company (herein referred to as "the Company"). Please complete a form for each applicant. No coverage will be effective until approved in writing by the Company. Complete all blanks in ink and print clearly. Incomplete forms will cause coverage to be delayed. Applicant Information: State Height Date Male Name of Birth / / of Birth Weight Female T.

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