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Get Nylife Election Of Dividend Option Form

This dividend option request also authorizes a change of mode to annual, if no other mode is selected, and/or the withdrawal of sufficient dividends to pay the balance of the premium due, if necessary. I understand that any insurance provided by an Expanded Protection Benefit rider will terminate on the date immediately preceding the policy anniversary when the new dividend option takes effect. Policyowner Information and Signature(s): Phone Number: Home ( ) Bes.

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