ࡱ>  ;bjbjVV <<5( D;;;l;L""""#(<K* ~JJJJJJJM7P.JMk+##k+k+J""4K000k+X""~J0k+~J00ZDF"V;+EjJK0L*E\eQ+JeQ0FeQF0k+k+k+JJ .k+k+k+Lk+k+k+k+eQk+k+k+k+k+k+k+k+k+ : VARIABLE LIFE LOAN AGREEMENTTO: POLICYOWNER SERVICES DEPARTMENT, VARIABLE LIFE SERVICE CENTER DIVISIONIMPORTANT LOAN INFORMATIONThe effective date of the loan will be the date the home office receives the loan request, provided the request is received prior to the close of trading on the New York Stock Exchange. Forms received after the close of the New York Stock Exchange will be processed effective the next business day. If you plan to rely on your policy's cash values to supplement current or future income needs, please be aware that cash values of variable insurance fluctuate daily in accordance with financial markets. Also, investment experience, dividend scale changes, unplanned loans or surrenders of additions, and unanticipated tax law changes could reduce the cash values available to fund such income. The cash value used as collateral for your loan will be placed in the company's general account and will not share in the investment experience of the underlying funds. Any outstanding loan balance will reduce the amount you or your beneficiary will receive upon surrender or death. If your policy is surrendered or terminated, your loan balance will be taxable as ordinary income to the extent it exceeds the basis of your policy. If there is not enough surrender value remaining in the policy to pay the tax, the tax will need to be paid with outside funds. Also, if the accumulated policy loan principal and interest can no longer be supported by the cash value, a required minimum out of pocket payment will be necessary, or the policy will terminate and trigger potentially significant taxable income. For additional information, contact your Northwestern Mutual Financial Representative, the home office, or your tax advisor.TAXPAYER IDENTIFICATION NUMBER AND WITHHOLDING INSTRUCTIONS (Complete section 3)If the policy is classified as a modified endowment contract, the loan balance is taxable currently as ordinary income to the extent of the gain in the policy and may also be subject to an additional 10% penalty tax. Under federal income tax law, if any portion of the payment you receive as a result of your execution of this form is reportable to the Internal Revenue Service ("IRS"), you will be subject to a withholding tax if you do not provide us with your Taxpayer Identification Number. Withholding taxes would also be imposed if the IRS notified us, before payment is made, that your Taxpayer Identification Number is incorrect. Generally speaking, for individuals, the Taxpayer Identification Number is the Social Security Number. By January 31 of next year, you will receive a statement from Northwestern Mutual showing the taxable portion of the loan payment, if determinable from our records, or the full amount of the payment, and showing the total of any income tax withheld during the year. You can use the amount of any tax withheld as a credit for taxes paid when you file your income tax return. When providing your Taxpayer Identification Number, indicate your withholding election. If withholding is elected, 10% of the taxable income amount will be withheld for federal taxes unless otherwise noted on the form. If one of the withholding boxes is not checked, taxes will not be withheld.PAYMENT INSTRUCTIONS Disbursements from trust owned contracts will be made payable to the trust only.DIRECT DEPOSIT: No Fee (Complete section 4) Direct deposit is convenient, secure, and saves time. This service is free of charge and is available for deposit into checking or saving account. Funds should be available two banking days after the loan is processed at Northwestern Mutual. Please attach a VOID check for checking account deposits. Your bank is identified by a Transit Number also referred to as an ABA Number. This number is the first set of nine digits at the bottom of your check. The Transit/ABA Number will always consist of nine digits. Direct Deposit is not the same as a bank wire. CHECK BY MAIL: No Fee (Complete section 5) The check will be sent via US mail the next business day after the loan is processed. CHECK BY FEDERAL EXPRESS: $15 Fee (Complete section 5 and 5A) The check will be delivered via Express Mail or Fed-Ex (depending on the mailing address) two business days after the loan is processed. There is a $15.00 fee which is deducted from the loan proceeds. BANK WIRE: $25 Fee (Complete section 6) The funds should be available one banking day after the loan is processed. Northwestern Mutual charges a $25.00 wire fee, which will be deducted from the loan proceeds. Your bank may also charge you an additional wire fee. Please verify with your bank what routing number should be used for incoming wires. APPLIED TO NORTHWESTERN MUTUAL CONTRACT: No Fee (Complete section 7) The funds can be used at the home office to pay a premium, Insurance Service Account (ISA) or to repay a loan.OPTIONS FOR SUBMITTING A REQUEST OR OBTAINING INFORMATIONFax: (preferred method) Completed form may be faxed to the home office at 414-625-4268. The original form need not be sent to the home office. Mail: Completed form may be mailed to Northwestern Mutual, Variable Life Service Center, 720 E. Wisconsin Avenue, Milwaukee, WI 53202 Call: 1-866-424-2609, M-F 7:00 AM 6:00 PM Central Time  VARIABLE LIFE LOAN AGREEMENTTO: POLICYOWNER SERVICES DEPARTMENT, VARIABLE LIFE SERVICE CENTER DIVISIONPolicy Debt. The policy debt is the amount currently advanced plus any previous policy debt. Interest. Interest shall be as provided by the policy or amendment thereto. Interest accrues and is payable on a daily basis from the date of the loan. Unpaid interest is included in the policy debt and is subject to interest on the same terms. Assignment The policy is assigned to the Northwestern Mutual Life Insurance Company as security for the policy loan. Termination If policy debt (including all interest accrued) shall on any date equal or exceed the cash value, the policy shall terminate, resulting in loss of coverage and possible adverse tax consequences. This will occur 31 days after a notice has been mailed to the Owner to the last known address and to any assignee on record at the Home office.1. CONTRACT INFORMATION (Please Print)Policy Number(s): FORMTEXT      Insured Name(s): FORMTEXT      Owner Name (Use Separate Form For Each Owner): FORMTEXT      Owner s Daytime Telephone No.:(  FORMTEXT     ) FORMTEXT      2. REQUESTED AMOUNT (Complete Only One) FORMCHECKBOX  Maximum Loan  FORMCHECKBOX  Specified Loan Amount $ FORMTEXT      3. TAX INFORMATIONOWNER TAXPAYER ID NUMBER  FORMTEXT      I elect to  FORMCHECKBOX  have  FORMCHECKBOX  not have federal or, if applicable, state income tax withheld from the above-requested payment. Under penalties of perjury, I certify that the number shown on this form is my correct Taxpayer Identification Number. (If no withholding selection is indicated, taxes will not be withheld.)Owner s current legal state of residence (state abbreviation): FORMTEXT   PAYMENT INSTRUCTIONS: Choose a method of delivery below. If no mailing directions are indicated, the check will be made payable to the owner and sent to the owners address on record.Disbursements from trust owned contracts will be made payable to the trust only.4. DIRECT DEPOSIT No Fee (A VOID CHECK is required if depositing to a checking account)Bank Name: FORMTEXT      Bank Transit Number: FORMTEXT      Name(s) as they appear on the account: FORMTEXT      Bank Account Number: FORMTEXT       FORMCHECKBOX  Checking - Attach a VOID check  FORMCHECKBOX  Savings (continued on next page) 5. CHECK BY MAIL No fee; If no mailing directions are indicated, the check will be sent to the owner address on record.Payable to:  FORMCHECKBOX  Owner  FORMCHECKBOX  Insured  FORMCHECKBOX  Other (specify) FORMTEXT       Address: FORMTEXT      City: FORMTEXT      State: FORMTEXT      Zip Code: FORMTEXT       FORMCHECKBOX  Check here if this is a permanent address change for:  FORMCHECKBOX  The Owner  FORMCHECKBOX  The Payer5A. FEDERAL EXPRESS INSTRUCTIONS $15.00 Fee(initials) I am aware a $15.00 fee will be deducted from the proceeds. FORMCHECKBOX  Leave without a signature OR  FORMCHECKBOX  Signature requiredPhone Number:(  FORMTEXT     ) FORMTEXT      (Federal Express will call in case of delivery problems)6. BANK WIRE $25.00 Fee; Your bank may also charge an additional wire fee.  FORMCHECKBOX  I authorize Northwestern Mutual to electronically transfer the amount directly to the listed bank and deposit the proceeds into the specified account. Funds should be received at the bank on the next business day after the loan is processed. (Please complete banking information below)(initials) I am aware a $25.00 fee will be deducted from the proceeds. Bank Name: FORMTEXT      Bank Transit Number (Check with your bank for their specific transit number for wire transfers): FORMTEXT      Name(s) as they appear on the account: FORMTEXT      Bank Account Number: FORMTEXT      7. PAYMENT APPLIED TO NORTHWESTERN MUTUAL CONTRACT A. Pay Policy(ies) Premium or Credit ISA(s)  FORMCHECKBOX  Pay Premium Policy Number FORMTEXT      to FORMTEXT      Amount $ FORMTEXT      (MM/DD/YYYY)  FORMCHECKBOX  Pay Premium Policy Number FORMTEXT      to FORMTEXT      Amount $ FORMTEXT      (MM/DD/YYYY)  FORMCHECKBOX  Credit ISA ISA Number FORMTEXT      to FORMTEXT      Amount $ FORMTEXT      (MM/DD/YYYY)  FORMCHECKBOX  Credit ISA ISA Number FORMTEXT      to FORMTEXT      Amount $ FORMTEXT      (MM/DD/YYYY) B. 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$$Ifa$gdfy  !$Ifgdfy<==n=====r  !$Ifgd  !$Ifgd8 $$Ifa$gd $Ifgd8 $IfgdM?kd$$Ifl4+,,,4 laf4yt+? $Ifgdfyn=p=================좗}k\TJ=hAhAOJQJ^Jh6y}CJOJQJh6y}OJQJjh85OJQJU\#j'heg5OJQJU\h6y}5OJQJ\jh6y}5OJQJU\h=bh6y}OJQJ"h=bh6y}5CJOJQJ\aJ%jh85CJOJQJU\aJ+jhA5CJOJQJU\aJh6y}5CJOJQJ\aJ%jh6y}5CJOJQJU\aJ==.>V>h>L=4( $$Ifa$gd $Ifgd8 $IfgdAkd$$Ifl4r &_(+ xa0,,4 laf4yt+?=====,>.>0>D>F>H>R>T>V>f>h>괧oVG?4h=bhxOJQJhAOJQJhx5CJOJQJ\aJ0jhA5CJOJQJU\aJmHnHu+jhA5CJOJQJU\aJhA5CJOJQJ\aJ%jhA5CJOJQJU\aJhAhxOJQJ^JhAhAOJQJ^J/j#hAhACJOJQJU^JaJ hAhACJOJQJ^JaJ)jhAhACJOJQJU^JaJh>j>~>>>>>>>>>>>>>>>>>>>𳫚{{sgWgDW:h6y}OJQJ^J%jh8CJOJQJU^Jjh6y}CJOJQJU^Jh6y}CJOJQJ^JhAOJQJhAhACJ OJQJaJ hAhACJ OJQJ\aJ hAhACJ OJQJ^JaJ hxOJQJhx5OJQJ\(jh}Xr5OJQJU\mHnHu#jh}Xr5OJQJU\h}Xr5OJQJ\jh}Xr5OJQJU\h>>>>0kd$$Ifl4r &_(+ xa0,,4 laf4yt?  !$Ifgd  !$Ifgd8>>>>>>  !$IfgdA $IfgdA $IfgdA>>>$?6?L=4( $$Ifa$gd $Ifgd8 $IfgdMkd$$Ifl4r &_(+ xa0,,4 laf4yt?>>>>>??? ?"?$?6?8?L?N?P?Z?\?̽̎|qbWEb6bjh85OJQJU\#jheg5OJQJU\h6y}5OJQJ\jh6y}5OJQJU\h=bh6y}OJQJ"h=bh6y}5CJOJQJ\aJ0jhA5CJOJQJU\aJmHnHu+jhA5CJOJQJU\aJhA5CJOJQJ\aJ%jhA5CJOJQJU\aJh6y}5OJQJ\^Jh6y}OJQJ^JhMOJQJ^J6?^?`?b?0kd$$Ifl4r &_(+ xa0,,4 laf4yt?  !$Ifgd  !$Ifgd8\?`?b?d?f????????????ϾϘzgXBg)0jhA5CJOJQJU\aJmHnHu+jhA5CJOJQJU\aJhA5CJOJQJ\aJ%jhA5CJOJQJU\aJ hAhxCJOJQJ^JaJhAhAOJQJ^JhACJOJQJ^JaJ/jhAhACJOJQJU^JaJ hAhACJOJQJ^JaJ)jhAhACJOJQJU^JaJhAOJQJ^Jh6y}CJOJQJh6y}OJQJb???? ,",  !$Ifgd  !$Ifgd8 $$Ifa$gd $Ifgd8 $IfgdM??????@,,,,,, ,$,&,,,.,0,2,d,ʻ|tcTPLE9h%hJ546CJaJ h.hJ54hJ54h?1h hY&iCJ OJQJaJ h hY&iCJ OJQJ^JaJ hxOJQJhx5OJQJ\(jhA5OJQJU\mHnHu#jmhA5OJQJU\UhA5OJQJ\jhA5OJQJU\h=bhxOJQJhAOJQJhx5CJOJQJ\aJ%jhA5CJOJQJU\aJRMTEXT       (continued on next page) Signature InstructionsPersonal Policyowner Policyowner must sign name as it appears in the policy contract. If the policy is jointly owned, all policyowners must sign. Business/Entity Owner(s) When signing on behalf of a business or entity, the signor must be someone authorized to conduct business other than the Insured. The name of the business/entity must be printed above the signature. If the Insured is the only one authorized to sign, a Statement of Apparent Authority form (18-1757) needs to be completed and submitted with this form. Trust Owner(s) The form must be signed by the authorized trustee(s) and the title Trustee must appear after each trustees signature. The name of the trust must be printed above each trustee signature. DISBURSEMENTS FROM TRUST OWNED CONTRACTS WILL BE MADE PAYABLE TO THE TRUST ONLY. Assigned Policy(ies) 1) If the policy is assigned, both the assignee and the owner must sign. 2) If the assignee is a business or entity, the signor must be someone authorized to conduct business other than the insured. The assignee must sign the form, and his or her title must appear after the signature. The name of the business/entity must be printed above the signature. 3) If the assignee is a personal assignee, the assignee must sign his or her name as it appears on the assignment. If the policy is jointly assigned, all assignees must sign.8. DATE AND SIGNATURE(S) OF OWNER(S), TRUSTEE(S) AND/OR ASSIGNEE(S)I have read this entire form (the Instructions page and pages 1 through 3) and I understand the potential tax consequences of this loan and effect of the loan on the policy(ies) noted within.]PersonaLLY OwneDSignature of Personal Owner Print or Type Name  FORMTEXT      Date Signed (MM/DD/YYYY)  FORMTEXT      Signature of Personal Owner Print or Type Name  FORMTEXT      Date Signed (MM/DD/YYYY)  FORMTEXT      Signature of Personal Owner Print or Type Name  FORMTEXT      Date Signed (MM/DD/YYYY)  FORMTEXT      Signature of Personal Owner Print or Type Name  FORMTEXT      Date Signed (MM/DD/YYYY)  FORMTEXT      BUSINESS/ENTITY OWNED When signing on behalf of business or entity, signor must be someone other than the Insured.Signature of Authorized Company Representative Print or Type Name of Business/Entity and Title  FORMTEXT      Date Signed (MM/DD/YYYY)  FORMTEXT      Signature of Authorized Company Representative Print or Type Name of Business/Entity and Title  FORMTEXT      Date Signed (MM/DD/YYYY)  FORMTEXT      TRUST OwneD Disbursements from trust owned contracts will be made payable to the trust only.Signature(s) of Trustee(s) Print or Type Name of Trust  FORMTEXT      Date Si",$,&,(,*,LC55  !$Ifgdfy $Ifgdfykd$$Ifl4r &_(+ xa0,,4 laf4yt+?*,,,.,0,2,d,f,h,j,rppiYTpF  !$Ifgd0ggd.$ #s]sa$gd.gd.kdY$$Ifl4pF &+ 0,,    4 laf4yt+?d,f,h,j,,,,,,,---{....Ƿݡ~fT?T*T(hsh*V@OJPJQJ^JnHtH(h-h*V@OJPJQJ^JnHtH"h*V@OJPJQJ^JnHtH.h-h*V5@OJPJQJ\^JnHtHh*VOJPJQJ^JnHtH$h-h*VOJPJQJ^JnHtH*h-h*V5OJPJQJ\^JnHtHhh;OJQJ\^J*hh;OJPJQJ\^JnHtHhhOJQJ^JhJ54h[@CJ aJ hJ54hJ54CJ aJ j,,,,--X/i/bO>O>Od$$7$8$H$Ifgd*Vd$$7$8$H$Ifgd*Vkdy$$Ifl40+@+ 0,,4 laf4pyt $Ifgd0g.X/^/h/i///v0w0000000r_LL8'h#>h*V5OJPJQJ^JnHtH$h-h*VOJPJQJ^JnHtH$h*V5OJPJQJ\^JnHtH"h*V@OJPJQJ^JnHtH.hRj`h*V5@OJPJQJ\^JnHtH(hRj`h*V@OJPJQJ^JnHtHh*VOJPJQJ^JnHtH'hkh*V5OJPJQJ^JnHtH*h-h*V5OJPJQJ\^JnHtH(h-h*V@OJPJQJ^JnHtHi/w0001222[R $Ifgd*Vfkd$$Ifl4R +,,0,,4 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Retain original form for your files.90-2198 (0910)(Page 2 of 3) FE FAX completed form to: The home office at 414-625-4268. 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