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Get Fidelity & Guaranty Life Insurance Company ADMIN 5587 2011-2024

Name and Address: (Directing annuity payments to another payee does not constitute a reduction in reportable income or tax liability to the owner). Standard Shipping: Overnight Shipping (not available for Systematic Withdrawals): Carrier: Account Number: CHECK ONE: PARTIAL SURRENDER Complete Sections 1, 5, 6, 7 FULL SURRENDER Complete Sections 2, 4, 5, 6, 7 SYSTEMATIC WITHDRAWAL REQUEST Complete Sections 3, 5, 6, 7 SECTION 1 - PARTIAL SURREND.

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