[logo: Lincoln National Life Insurance Co.
-----------------------------------
a part of LINCOLN NATIONAL CORPORATION]
The Lincoln National Life Insurance Company
Administrator Mailing Address: 350 Church St., Hartford, CT 06103-1106
Supplement to Application for
Variable Life Insurance
Supplement to Application - INDIVIDUAL OWNER
1. Proposed Insured _________________________________________________________
First Middle Last
2. Premium Payment Allocation (Indicate Whole Percentages. Percentages must
equal 100%.)
[American Century Variable Products Group, Inc. Lincoln National Funds
_____% VP Income and Growth Fund _____% Bond Fund, Inc.
_____% VP International Fund _____% Capital Appreciation Fund, Inc.
American Variable Insurance Series _____% Equity-Income Fund, Inc.
_____% Global Growth Fund - Class 2 _____% Money Market Fund, Inc.
_____% Growth Fund - Class 2 _____% Social Awareness Fund, Inc.
Baron Capital Funds Trust MFS Variable Insurance Trust
_____% Asset Fund _____% Research Series
BT Insurance Funds Trust _____% Total Return Series
_____% EAFE Equity Index Fund _____% Utilities Series
_____% Equity 500 Index Fund _____% Value Series
_____% Small Cap Index Fund Neuberger & Berman Advisers Management Trust
Delaware Group Premium Fund, Inc. _____% Mid-Cap Growth Portfolio
_____% Delchester Series _____% Partners Portfolio
_____% Devon Series OCC Accumulation Trust
_____% International Series _____% Managed Portfolio
_____% REIT Series OppenheimerFunds
_____% Small Cap Value Series _____% Growth and Income Fund
Fidelity Variable Insurance Products Fund Templeton Variable Products Series Fund
_____% VIP Growth Portfolio - Service Class _____% Asset Allocation Fund - Class 2
_____% VIP II Asset Manager Portfolio - Service Class _____% International Fund - Class 2
_____% VIP II Contrafund Portfolio - Service Class _____% Stock Fund - Class 2]
Janus Aspen Series
_____% Aggressive Growth Portfolio
_____% Balanced Portfolio
_____% Worldwide Growth Portfolio
Owner's Suitability
The rules of the National Association of Securities Dealers, Inc. require that
the Sales Representative have reasonable grounds to believe that the sale is
suitable for the Owner, based on information provided by the Owner as shown on
this form and on information known by the Sales Representative.
3. Owner's Taxpayer Identification Number:
[ ] Individual [ ][ ][ ]-[ ][ ]-[ ][ ][ ][ ]
4. Age: ___________________________________________________________
5: Citizenship: ___________________________________________________
6. Marital Status: ________________________________________________
7. Number of Dependents: __________________________________________
8. Occupation: ____________________________________________________
9. Employers' Name(s) & Address: _____________________________________________
___________________________________________________________________________
B10394
10. Investment Objectives (check all applicable objectives)
[ ] Capital Preservation
[ ] Tax Advantage/Deferral
[ ] Current Income
[ ] Growth and Income
[ ] Growth
[ ] Aggressive Growth
[ ] Other (please specify) __________________________________
11. Insurance Objectives (check all applicable objectives)
[ ] Estate Creation
[ ] Estate Conservation
[ ] Other (please specify) __________________________________
12. Investment Knowledge: [ ] Limited [ ] Good [ ] Extensive
13. Risk Tolerance: [ ] None [ ] Low [ ] Medium [ ] High
14. Is the coverage in accord with the Owner's insurance objectives and
anticipated financial needs? [ ] Yes [ ] No
15. Total Income of Owner's Immediate Family
[ ] $250,000+
[ ] $100,000 - $249,999
[ ] $50,000 - $99,999
[ ] $25,000 - $49,999
[ ] Under $25,000
16: Estimated Net Worth of Owner's Immediate Family
[ ] $1,000,000+
[ ] $500,000 - $1,000,000
[ ] $250,000 - $500,000
[ ] $100,000 - $250,000
[ ] Under $100,000
17. Federal Tax Bracket: [ ] 15% [ ] 28%
[ ] Other (please specify) __________________________________
18. Is the Owner associated with a National Association of Securities Dealers,
Inc. firm? [ ] Yes [ ] No
19. If jointly, or business, owned, please provide the name(s) and signature(s)
of the person(s) authorized to exercise ownership rights: _________________
___________________________________________________________________________
I understand that:
THE AMOUNT AND DURATION OF THE DEATH BENEFIT MAY VARY UNDER SPECIFIED
CONDITIONS.
VALUES NOT IN THE FIXED ACCOUNT MAY INCREASE OR DECREASE IN ACCORDANCE WITH
THE EXPERIENCE OF THE SEPARATE ACCOUNT.
THE AMOUNT OF THE MATURITY BENEFIT IS NOT GUARANTEED BUT IS DEPENDENT UPON
THE THEN SURRENDER VALUE.
ILLUSTRATIONS OF BENEFITS, INCLUDING DEATH BENEFITS, ACCOUNT VALUES, AND
SURRENDER VALUES ARE AVAILABLE UPON REQUEST.
I hereby acknowledge receipt of the Prospectus dated ___________________ for all
applicable prospectus(es) pertaining to the Separate Account and all of the
variable options.
Signed at __________________________ on ______________________
(City, State) (Mo/Day/Yr)
By _____________________________________ By ___________________________________
Signature of Owner Signature of Owner
Based on information obtained from the Owner, I believe the investment is
suitable for the Owner's objectives.
______________________________________ on ________________________
Signature of Registered Representative (Mo/Day/Yr)
[logo: Lincoln National Life Insurance Co.
-----------------------------------
a part of LINCOLN NATIONAL CORPORATION]
The Lincoln National Life Insurance Company
Administrator Mailing Address: 350 Church St., Hartford, CT 06103-1106
Supplement to Application for
Variable Life Insurance
Supplement to Application - BUSINESS OWNER
1. See attached census for listing of proposed Insureds.
2. Premium Payment Allocation (Indicate Whole Percentages. Percentages must
equal 100%.)
[American Century Variable Products Group, Inc. Lincoln National Funds
_____% VP Income and Growth Fund _____% Bond Fund, Inc.
_____% VP International Fund _____% Capital Appreciation Fund, Inc.
American Variable Insurance Series _____% Equity-Income Fund, Inc.
_____% Global Growth Fund - Class 2 _____% Money Market Fund, Inc.
_____% Growth Fund - Class 2 _____% Social Awareness Fund, Inc.
Baron Capital Funds Trust MFS Variable Insurance Trust
_____% Asset Fund _____% Research Series
BT Insurance Funds Trust _____% Total Return Series
_____% EAFE Equity Index Fund _____% Utilities Series
_____% Equity 500 Index Fund _____% Value Series
_____% Small Cap Index Fund Neuberger & Berman Advisers Management Trust
Delaware Group Premium Fund, Inc. _____% Mid-Cap Growth Portfolio
_____% Delchester Series _____% Partners Portfolio
_____% Devon Series OCC Accumulation Trust
_____% International Series _____% Managed Portfolio
_____% REIT Series OppenheimerFunds
_____% Small Cap Value Series _____% Growth and Income Fund
Fidelity Variable Insurance Products Fund Templeton Variable Products Series Fund
_____% VIP Growth Portfolio - Service Class _____% Asset Allocation Fund - Class 2
_____% VIP II Asset Manager Portfolio - Service Class _____% International Fund - Class 2
_____% VIP II Contrafund Portfolio - Service Class _____% Stock Fund - Class 2]
Janus Aspen Series
_____% Aggressive Growth Portfolio
_____% Balanced Portfolio
_____% Worldwide Growth Portfolio
Owner's Suitability
The rules of the National Association of Securities Dealers, Inc. require that
the Sales Representative have reasonable grounds to believe that the sale is
suitable for the Owner, based on information provided by the Owner as shown on
this form and on information known by the Sales Representative.
3. Owner's Taxpayer Identification Number: [ ][ ]-[ ][ ][ ][ ][ ][ ][ ]
Type of Entity:
[ ] Corporation [ ] S-Corporation [ ] Non-Profit Organization
[ ] General Partnership [ ] Limited Partnership [ ] Sole Proprietorship
[ ] Other
4. Type of Business: _________________________________________________________
5: Approximate annual income [ ] Under $1,000,000 [ ] $1,000,001 to $10,000,000
(All Sources) [ ] $10,000,001 to $50,000,000 [ ] Over $50,000,000
6. Total Assets: [ ] Under $1,000,000 [ ] $1,000,001 to $10,000,000
[ ] $10,000,001 to $50,000,000 [ ] Over $50,000,000
B10395
7. Investment Objectives (check all applicable objectives)
[ ] Capital Preservation
[ ] Tax Advantage/Deferral
[ ] Current Income
[ ] Growth and Income
[ ] Growth
[ ] Aggressive Growth
[ ] Other (please specify) _____________________________________
8. Please provide a brief description of your insurance objective in obtaining
this coverage: ____________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
9. Is the Owner associated with a National Association of Securities Dealers,
Inc. firm? [ ] Yes [ ] No
10. Have the proper corporate resolutions been adopted authorizing the
acquisition of this coverage and exercise of rights thereunder:
[ ] Yes [ ] No
Lincoln Life reserves the right to require you to provide a copy of such
resolutions.
11. Please identify and provide the name(s) and signatures(s) of the
officer(s), partner(s), or individual(s) authorized to exercise ownership
rights:
__________________________________________________________________________
Print Name Title Signature
__________________________________________________________________________
Print Name Title Signature
__________________________________________________________________________
Print Name Title Signature
I understand that:
THE AMOUNT AND DURATION OF THE DEATH BENEFIT MAY VARY UNDER SPECIFIED
CONDITIONS.
VALUES NOT IN THE FIXED ACCOUNT MAY INCREASE OR DECREASE IN ACCORDANCE WITH
THE EXPERIENCE OF THE SEPARATE ACCOUNT.
THE AMOUNT OF THE MATURITY BENEFIT IS NOT GUARANTEED BUT IS DEPENDENT UPON
THE THEN SURRENDER VALUE.
ILLUSTRATIONS OF BENEFITS, INCLUDING DEATH BENEFITS, ACCOUNT VALUES, AND
SURRENDER VALUES ARE AVAILABLE UPON REQUEST.
I hereby acknowledge receipt of the Prospectus dated __________________ for all
applicable prospectus(es) pertaining to the Separate Account and all of the
variable options.
Signed at __________________________ on ______________________
(City, State) (Mo/Day/Yr)
By _____________________________________ By ___________________________________
Signature of Owner Signature of Owner
Based on information obtained from the Owner, I believe the investment is
suitable for the Owner's objectives.
______________________________________ on ________________________
Signature of Registered Representative (Mo/Day/Yr)