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In Good Order Annuity Application Cover Sheet

Congratulations! Your application is In Good Order!

Transaction ID: Application Date:

Proposed

Annuitant:

Annuitant DOB:

Product: Application State:

Check Amount: Check Number:

Agent: Agent ID:

Agency Name:

Agents Remarks:

For BGA portal use only:

Office ID: Producer ID:

Case Manager: Profile#:

Instructions:

Case Manager

Remarks:

Unique Identifier:

ATRS

Kenneth R Pinkney 5500079429

965404X

2883dc26-d8cb-4445-b902-889d2d19e65b-104155812

02/28/1987Markita Tillman

LSW SecurePlus Elite 5

01/26/2016

TX

11525(0114)

Page 1 of 4 Cat. No. 102031

LR 12518

SecurePlus Series Flexible Premium Indexed Annuity PolicyAnd Guaranteed Lifetime Income Rider Disclosure

National Life Group is a trade name representing various affiliates, which offer a variety of financial service products.P: 800-732-8939 F: 214-638-9162 [email protected] www.NationalLifeGroup.com Centralized Mailing Address: One National Life Drive, Montpelier, VT 05604-5555 Home Office: 15455 Dallas Parkway, Suite 800, Addison, TX 75001

This Disclosure reviews important points to consider before you2 purchase a SecurePlus Series annuity and, if elected, the Guaranteed Lifetime Income Rider (GLIR). Please refer to the Product Specification page at the end of this Disclosure for specific details regarding benefits, charges, limitations, and additional features of the SecurePlus Series annuity and GLIR.

Section I The Annuity PolicySecurePlus Flexible Premium Indexed Annuity is a tax deferred3 annuity, which means all amounts in the annuity accumulate with federal and state income tax deferred until withdrawn or received as income. You can use the annuity to save for retirement and to receive retirement income for life. It is not meant to be used to meet short-term financial goals.How will the value of my annuity grow? Your annuity's Accumulation Value will grow through the payment of additional premium, if you so choose, and by any credited interest. You may pay multiple premiums into your annuity. The Accumulation Value equals your premium paid (net of any applicable state taxes), plus credited interest, minus any applicable rider charges, minus any partial withdrawals taken (including any Withdrawal Charges assessed).

How is interest calculated and credited?The Declared Interest Accounts credit interest daily at an annual effective rate we set in advance for each Account Year. The rate guaranteed on the issue date and the minimum rate thereafter will be shown in your policy. Neither rate will be less than 1%.

What is the framework for crediting interest?You may allocate your Accumulation Value to any combination of the Interest Accounts shown on the Specification Page in whole percentages. On the day the premium is received, it is placed in the Premium Account. The Premium Account earns interest daily at an annual effective rate no less than 1%. Once per month, the entire value of the Premium Account is transferred to the selected Interest Accounts. The date that an Interest Account is established, and the dates at 12-month intervals thereafter are called the Reset Dates for that Account. The period from the Reset Date when an Interest Account is established to the Reset Date in the next year, and each one-year period thereafter, is an Account Year for that Account. We maintain each Interest Account separately.

The Indexed Interest Accounts credit interest at the end of each Account Year, based in part on the annual change of an underlying index. The index reflects capital growth only and excludes dividends paid on its stocks. The interest rate credited to an Indexed Interest Account is the Index Rate multiplied by the Annual Percentage Change (described below), the result being subject to a minimum called the Floor and a maximum called the Cap. The Floor is 0%. We set the Index Rate and Cap for each Indexed Interest Account in advance for each Account Year. The Index Rates and Caps guaranteed on the issue date and the minimum rates thereafter will be shown in your policy. The Index Rate will be no less than 10%, and the Cap will be no less than 1%. You have the ability to select Indexed Interest Accounts that use either the Ending Index and/or Average Index crediting methods (Average Index not available on all policies). The Annual Percentage Change for each type of Indexed Interest Account is determined as follows. If you select Index Interest Accounts using the Ending Index method, the Annual Percentage Change is the change in the index value from the beginning of the Account Year to the index value at the end of the Account Year. If you select Index Interest Accounts using the Average Index method, the Annual Percentage Change is the change in the index value from the beginning of the Account Year to the average of the daily index values for all open stock market days during the Account Year.

Leave with Applicant

The following table provides examples of how to determine the indexed interest in various hypothetical situations:In the first example, the indexed interest is determined as follows:

Your agent can provide information about the current guaranteed interest rates, Index Rates, and Caps. Please note that such rates are subject to change without notice.

Exam

ple

Index

Rate

Hypo

thetic

al An

nual

Perce

ntage

Ch

ange

Multip

lied

Resu

lt

Cap

Floor

0.00%3.00%8.00%

0.00%1.00%-0.80%0.00%No Cap-2.40%0.00%3.00%-8.00%0.00%1.00%0.80%0.00%No Cap2.40%

Index

ed

Inter

est

Cred

ited

3.00%

0.00%0.00%0.00%0.80%2.40%

1 100.00% 8.00%

6 10.00% -8.00%5 30.00% -8.00%4 100.00% -8.00%3 10.00% 8.00%2 30.00% 8.00%

Step 1: Multiply the Index Rate (which had been declared at the beginning of the Account Year) by the Annual Percentage Change.

100.00% x 8.00% = 8.00%Step 2: Compare this to the Cap of 3.00% (which also had been declared at the beginning of the Account Year) and a Floor of 0.00%. The Cap is smaller, since 8.00% is greater than the Cap of 3.00%.Step 3: The interest rate credited is limited to the Cap of 3.00%. The interest rate credited is 3.00%. Examples 1 - 3 assume a positive Annual Percentage Change. Examples 4 - 6 assume a negative Annual Percentage Change. Examples 1 and 4 assume a hypothetical Index Rate and Cap for an account that uses the Ending Index method. Examples 2 and 5 assume a hypothetical Index Rate and Cap for an account that uses the Average Index method. Examples 3 and 6 assume the guaranteed minimum Index Rate and Cap for an Indexed Interest Account.

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How do I transfer amounts in my annuity among Interest Accounts?Transfers between and among Interest Accounts of different types may be made only on the Reset Date of the Interest Account(s) from which the transfer is to be made and only after our receipt of your written request for the transfer 15 days prior to the Reset Date. The prospective rates applicable to the transferred amount will be the same rates as if its premium had been originally allocated to the new Interest Account(s).

What happens if I take out some or all of the money from my annuity?All withdrawals from the annuity may be subject to a Withdrawal Charge. After the first Policy Year4, you may withdraw up to 10% of the Accumulation Value in any one year, without incurring a Withdrawal Charge (Free Withdrawal Amount). Withdrawal Charges are a percentage of the amount withdrawn in excess of this Free Withdrawal Amount. Contractually, the minimum partial withdrawal you may request is $500, and your Accumulation Value must be no less than $2,500 after the withdrawal. Note: All withdrawals are subject to the qualified plan's eligibility requirements, if applicable.What happens after I die?If you die before we start to pay you periodic income under the Payment Options of your annuity, your beneficiary can choose to receive the death benefit as one payment or as a series of payments over time. If you are the Annuitant, the death benefit is the greater of the Accumulation Value or the Policy Value. If you are the Owner but not the Annuitant, the death benefit is the Cash Value. If your death occurs after periodic income payments have begun, any payments which remain to be paid under your payment option selection will be paid to your beneficiary.

How do I get income (payouts) from my annuity6?If you convert your annuity to income, we will calculate the income using the Cash Value. If you do so after the number of Policy Years specified in your Policy, any applicable Withdrawal Charges will be waived. Your annuity policy describes your options in detail. Your current choices are: Designated period of time: Guarantees income for a chosen period, from five to 25 years. Life: Guarantees income for as long as you live.

Joint and survivor life: Guarantees income for as long as you or your joint annuitant live.

Life income with a period certain: Guarantees income for as long as you live or for a chosen period, whichever is longer. If you die within the period certain, the income continues to your beneficiary for the remainder of the period certain. Periods certain are 10 years, 20 years and Installment Refund (income continues until the amount paid is at least the amount applied).

You may also elect a lifetime withdrawal benefit if you purchase the Guaranteed Lifetime Income Rider.

Can I take a loan from my annuity5?If you purchase the annuity as part of a 403(b) or 457(b) plan and your employer's plan permits loans, you may request a loan while pledging your annuity as collateral. The loan interest rate charged is a variable loan interest rate based on Moody's Corporate Bond Yield Average. The amount available to be borrowed is limited by law, plan guidelines and company rules. For more information, please see the loan rider in your policy.

Section II - Access to ValueThe Accumulation Value of your policy is accessible to meet your needs. You may take a full or partial withdrawal, fulfill a Required Minimum Distribution requirement, begin payments under the GLIR (described below) if applicable, receive annuitized payments or receive policy loans (loans only available on 403(b) or 457(b) policies when approved by plan and available by law). All withdrawals are subject to federal income tax, state income tax and may be subject to withdrawal charges.You may make a total or partial withdrawal, or you may request that your annuity be converted to periodic income. These benefits will be based on the Accumulation Value, Cash Value and/or Policy Value of your annuity. The Accumulation Value is previously described. The Cash Value of your annuity is equal to the larger of the Accumulation Value less applicable Withdrawal Charges or the Policy Value. The Policy Value equals a percentage of the premiums less withdrawals taken, accumulated daily at an annual effective interest rate of no less than 1%. The percentage of premiums will be no less than 87.5% (set forth in Part 4: Policy Dates and Values of your Policy).

Guaranteed Withdrawal Percentage DeterminationThe Guaranteed Withdrawal Percentage is determined by the payment option selected and by the age of the Annuitant on the date we make the first payment. The payment options are: Single Life Option, Joint Life Option (based on the age of the younger of the Annuitant or the Annuitant's spouse), and Enhanced Benefit Option (not available in some states; see Rider for eligibility requirements)

Section III - Guaranteed Lifetime Income Rider (GLIR) - not available in all statesYou have the ability at issue to add the GLIR if available in your state. Under the Guaranteed Lifetime Income Rider (the Rider), you may receive specified withdrawal payments from the annuity that extend for your lifetime or for the joint lifetime of you and your spouse, even if the withdrawal payments completely deplete the values in the annuity. Without the Rider, the annuity terminates when the values of the annuity reduce to zero.Withdrawal Benefits under the GLIR


The Accumulation Period is the time period before the date you elect in writing to exercise withdrawals based on the Rider income calculation formula. These withdrawals are referred to as Guaranteed Withdrawal Payments. The Withdrawal Period begins on the date of the first Guaranteed Withdrawal Payment. You can begin taking Guaranteed Withdrawal Payments when the Annuitant has attained the minimum required age, the Policy has been in force for at least one year, and when all Policy loans, if any, have been repaid. The initial Guaranteed Withdrawal Payment is determined at the time of the first payment and equals the Guaranteed Withdrawal Percentage multiplied by the greater of the Income Calculation Base or the Accumulation Value. The Guaranteed Withdrawal Payment is the maximum annual withdrawal benefit provided by the Rider. You can request that the Guaranteed Withdrawal Payment be paid in monthly, quarterly, semi-annual, or annual installments. All withdrawals, whether elected under the Rider or the terms of the Policy itself, reduce the values of the annuity.

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Income Calculation Base DeterminationThe Income Calculation Base is used solely to determine Rider benefits. It is not a Policy benefit or value. When Guaranteed Withdrawal Payments begin, the Income Calculation Base ceases to exist. The Income Calculation Base is determined by applying a Rollup Rate to each premium payment. Rollup Rates are set individually for the portion of the Income Calculation Base that is established by each premium payment. The initial Rollup Rate for each premium will be the rate in effect at the time the premium is received and will apply for a guaranteed number of years from receipt (outlined in the Rider issued with your Policy). After the guaranteed period, the Rollup Rate for that premium will be set annually in advance and will never be less than three (3) percent. After a specified number of Policy Years (listed on the Specification Page), Rollup Rates no longer apply. The Income Calculation Base will automatically increase to equal the Accumulation Value, if higher, every five years.Effects of Other Withdrawals on Rider BenefitsDuring the Accumulation Period, all withdrawals decrease the Income Calculation Base proportionately. For example, a 10% withdrawal from the Accumulation Value will reduce the Income Calculation Base by 10% as well. During the Withdrawal Period, all withdrawals are first applied against the Guaranteed Withdrawal Payment. Generally speaking, Guaranteed Withdrawal Payments are not subject to Withdrawal Charges. If you request a withdrawal during a Policy Year that exceeds the Guaranteed Withdrawal Payment, the excess amount is termed an Excess Withdrawal and will cause a proportional reduction in the Guaranteed Withdrawal Payment in future Policy Years. For example, if you started taking a maximum Guaranteed Withdrawal Payment of $1,500 and, three years later, you requested an additional $12,000 withdrawal from the Policy, your Guaranteed Withdrawal Payment would be reduced.

Cost of the RiderA Rider Charge is deducted from each Interest Account at the end of each Account Year. The Rider Charge equals the Rider Charge Rate times the value of the Interest Account.CancellationYou may terminate the Rider (and any future charges) after the Rider has been in force for five (5) years by giving us written notice at least thirty (30) days prior to the Policy anniversary on which the termination is to take effect.

If the Accumulation Value before the Excess Withdrawal of the additional $12,000 was, say, $120,000, the Excess Withdrawal would represent 10% of the Accumulation Value. The future Guaranteed Withdrawal Payment would be reduced by 10%, to $1,350. You would continue to receive $1,350 annually for life, assuming no future Excess Withdrawals.

If the Accumulation Value before the Excess Withdrawal of the additional $12,000 was, say, $24,000, the Excess Withdrawal would represent 50% of the Accumulation Value. The future Guaranteed Withdrawal Payment would be reduced by 50%, to $750. You would continue to receive $750 annually for life, assuming no future Excess Withdrawals.

If the Accumulation Value before the Excess Withdrawal of the additional $12,000 was exactly $12,000, the Excess Withdrawal would represent 100% of the Accumulation Value. The future Guaranteed Withdrawal Payment would be reduced by 100%, and the Guaranteed Withdrawals and the Policy itself would both terminate.

In these examples, in the year of the Excess Withdrawal, your total withdrawal benefits are $13,500.

Section IV - Fees, Expenses & Other ChargesDo I pay any fees or charges?The annuity has no fees or expenses charged against your Accumulation Value. There is a charge for the GLIR (current charges listed on the Specification Page). Charges for the rider are applied as described above. Some states charge a premium tax on annuities, in addition to any applicable state income tax. If we must pay this tax, we will deduct it from your premium, from your policy's values or from policy benefits as is appropriate (see "How are state premium taxes assessed?" below).

How will payouts and withdrawals from my annuity be taxed?When you receive income or make a withdrawal, you pay ordinary income taxes on the taxable value. If you make a withdrawal before age 59, you may be subject to a 10% federal income tax penalty unless you qualify under any exceptions provided by law.How are state premium taxes assessed?As of the date of publication of this document, states assessing premium taxes and the method of handling are shown below. We will apply state premium taxes for each premium received in accordance with the state law at the time of premium receipt, withdrawal, or annuitization. Please note that any state may institute a premium tax that may be applicable to premiums paid into policies after issue, whether or not the policy was issued prior to the existence of the premium tax.

Section V - TaxesYou should consult your own tax advisor for tax advice.


Residents of Maine: The State of Maine imposes a state premium tax of 2% of all premiums paid to non-qualified annuities. We deduct 2% from your premium and pay this to the state. We apply the remaining 98% of the premium to the Accumulation Value. Since the Cash Value may depend on the Accumulation Value, the Cash Value may be reduced as a result of the state premium tax.Residents of South Dakota and Wyoming: The State of South Dakota imposes a state premium tax of 1.25% and the State of Wyoming imposes a state premium tax of 1% of all premiums paid to non-qualified annuities. We deduct this amount from your premium and pay this to the state. We apply the remaining amount of the premium to the Accumulation Value. Since the Cash Value may depend on the Accumulation Value, the Cash Value may be reduced as a result of the state premium tax.

11525(0114) Page 4 of 4


Residents of California: The State of California imposes a 0.50% state premium tax in the case of qualified annuities and a 2.35% state premium tax in the case of non-qualified annuities. This tax is assessed on Withdrawal Charges in the case of a Total or Partial Withdrawal. It is assessed on amounts withdrawn to provide a periodic income. We deduct the amount of the tax from the amount withdrawn and pay this to the state. We then provide or apply the remaining amount as is appropriate at that time.Residents of Nevada and West Virginia: The State of Nevada imposes a state premium tax of 3.5% in the case of non-qualified annuities while the State of West Virginia imposes a state premium tax of 1% in the case of both qualified and non-qualified annuities. This tax is assessed on amounts withdrawn to provide a periodic income. We deduct the amount of the tax from the amount withdrawn and pay this to the state. We then apply the remaining amount as is appropriate at that time.

What should I know about Life Insurance Company of the Southwest?Life Insurance Company of the Southwest is a life insurance company that specializes in annuity and life insurance products. Our goal is to provide products that benefit policyholders regardless of market conditions. We were incorporated in 1955 under the laws of Texas as a legal reserve insurance company and are licensed in 49 states and the District of Columbia. We are a member of National Life Group, which is a diversified family of financial services companies that has successfully forged a strong identity as a product innovator offering personalized service. Companies in the National Life Group offer a comprehensive portfolio of life insurance, annuity and investment products to help individuals, families and businesses pursue their financial goals.

Acknowledgement and UnderstandingPlease do not rely on any statement about the annuity that is not consistent with what is described in this Disclosure or in any other material written by us and provided to you. In case of any ambiguity, conflict or question regarding interpretation of this Disclosure or any other published materials or statements, the provisions of the Policy form prevail. Please consult your annuity Policy form for further details.

1 Guarantees are dependent on the claims paying ability of the issuing company.2 When we use the words, you and your in this Disclosure, we mean the applicant of the annuity. We, us and our mean Life Insurance Company of the Southwest.3 Annuities owned by certain trusts or corporate entities may not enjoy the tax deferral feature. Buying an annuity within a tax-deferred retirement plan does not provide tax benefits beyond what are provided by these qualified arrangements. If considering an annuity within a retirement plan, base your decision on the annuity's other features and benefits as well as its risks and costs, not on its tax benefits.

4 Policy Years are yearly periods which start on the issue date and on the same month and day each year thereafter.

5 Loans are added by rider, Form 7914 or 20099(0112) or a state variation thereof, which is not available in all states. All 403(b) and 457(b) annuities must be associated with an employer plan. Hardship withdrawals and loans are also subject to any restrictions listed in your employer's plan documents. Loans are not available on Roth 403(b) or Roth 457(b).

6 Benefits at annuitization could be reduced if a misstatement of age or gender has occurred.

Bonus Accumulation Value (BAV) - The BAV that will transfer tothe Accumulation Value if certain requirements are met. During Policy Years one through ten, the BAV is equal to 5% of the Accumulation Value. On Policy Date anniversaries 11 through 15, a portion of the BAV is transferred to the Premium Account if your annuity meets the Premium Test on the tenth policy anniversary and your annuity is in force on the transfer date. When a portion of the BAV is transferred, it becomes part of the Accumulation Value and is no longer part of the BAV. The Premium Test is met if either or both of the following two conditions are met: Total premiums paid less partial withdrawals taken is at least two times the total premiums paid in the first Policy Year, or Total premiums paid less partial withdrawals taken is greater than or equal to $20,000.

Declared Interest

Issue age limits for this annuity are owner/annuitant age 0-55 (0-54 in OH) Minimum Premium: Qualified - $100 per month salary reduction/deduction; Non-Qualified and IRA - $100 per month, automatic bank draft. Cumulative Maximum premium for Qualified Annuities: Issue ages 0-55 - $750,000. Annual premium limit for Non-Qualified Annuities: $25,000; Cumulative Maximum premium for Non-Qualified annuities: Issue ages 0-55 - $250,000. Qualified and Non-Qualified premium limits are per life and are subject to change. Refer to policy/endorsement for actual limits. Determination of Qualified and Non-Qualified status is made by Company. Transfer, rollover and exchange premiums may only be paid during the first five Policy Years into policies actively receiving flex premium. This annuity is designed for people who are willing to let their savings build for at least fifteen years.

S&P 500 Ending Index Russell 2000 Ending Index

SecurePlus Elite 5 is Policy Form 7967, 7968TX(0612), or state variation thereof.The Guaranteed Lifetime Income Rider is Rider Form 20135(0613), 20136(0613), 7964, 7966, or a state variation thereof.

The portion of the remaining BAV that is transferred to the Premium Account is as follows:

Policy Date anniversary

% of remaining BAV transferred

11

20%

15

100%

14

50%

13

331/3%

12

25%

Please understand that you have no right to or interest in the BAV unless and until it is transferred to the Accumulation Value. Withdrawals reduce the value of the BAV in the same proportion as the Accumulation Value is reduced.

Types of Interest Accounts that may be established on the 14th of each month:

Standard & Poor's, S&P, S&P 500, Standard & Poor's 500, and 500 are trademarks of The McGraw-Hill Companies, Inc. and have been licensed for use by Life Insurance Company of the Southwest. The product is not sponsored, endorsed, sold or promoted by Standard & Poor's and Standard & Poor's makes no representation regarding the advisability of purchasing the product. The Russell 2000 Index is a trademark of Russell Investment Group and has been licensed for use by Life Insurance Company of the Southwest. The product is not sponsored, endorsed, sold or promoted by Russell Investment Group and Russell Investment Group makes no representation regarding the advisability of purchasing the product.

Guaranteed Lifetime Income Rider Request and Understanding - Not Available in NJ, OR & WAIf indicated on the application that the Guaranteed Lifetime Income Rider ("Rider") will be issued with my Policy; I understand that the Rollup Rate, Guaranteed Withdrawal Percentages and Rider Charge Rates will be those in effect on the date the annuity is issued.Additional Rider DetailFlexible Premium Policies issued as a 403(b) or 457(b)

Rider Charge is 0.70% for all Policy Years Maximum Roll-up Rate period - 20 policy years

Flexible Premium Policies issued as any other qualification Rider Charge

Maximum Roll-up Rate period - 30 policy years

0.70% prior to the 21st Policy anniversary 0.80% on or after the 21st Policy anniversary At election of Guaranteed Withdrawal Payments, the Rider ChargeRate is the rate being applied at the time of election, whether 0.70% or 0.80%.

Withdrawal ChargesPolicy Year 1 2 3 4 5 6 7 8 9 10 11 13+12

Standard 12345678910 012 11

1403(b)/457(b) TX only 10 9 8 7 6 5 4 3 2 1 01

Form No. 11529

Page 1 of 3 Cat. No. 102034

LR 12531 Rev. 0215

Product Specification Page SecurePlus Elite 5 and

Guaranteed Lifetime Income Rider

National Life Group is a trade name representing various affiliates, which offer a variety of financial service products.P: 800-732-8939 F: 214-638-9162 [email protected] www.NationalLifeGroup.com Centralized Mailing Address: One National Life Drive, Montpelier, VT 05604-5555 Home Office: 15455 Dallas Parkway, Suite 800, Addison, TX 75001


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The following table shows a range of Single Life Annual Guaranteed Withdrawal Payments under various issue and election ages.

The minimum issue age is 40 unless the policy is issued as 403(b) or 457(b) in which case the minimum issue age is 25. The minimum election age is 60 unless the policy is issued as 403(b) or 457(b) in which case the minimum election age is 55.1. The figures above reflect a range of benefits and assume a $100 initial premium with ongoing $100 premiums paid monthly thereafter for 20 years or until election if earlier. The benefits can be more or less than the Current or Midrange payment but can never be less than the Guaranteed payment.2. The chart on this page shows the range of Rollup Rates used to determine the Income Calculation Base from which the benefits shown above were calculated. The initial Rollup Rate for each premium is guaranteed for 10 years from receipt. Rollup Rates no longer apply after 20 Policy Years unless the policy is issued as 403(b) or 457(b) in which case Rollup Rates no longer apply after 30 Policy Years.3. Current Rollup Rates shown are in effect as of date of calculation. Rates may differ by date of issue. The above calculations ignore state taxes. Rider benefits may be affected by state taxes in CA, ME, NV, SD, WV, and WY.4. The Guaranteed Lifetime Income Rider is not available in all states.

Current Rollup Rates

Midrange Rollup Rates

Guaranteed Rollup Rates

1-10 Years

Ongoing Premium

5.0%6.0% 3.0%6.0%6.0%6.0%

5.0%5.0% 3.0%3.0%6.0%6.0%

11-20 Years

1-10 Years

11-20 Years

1-10 Years

11-20 Years

Initial Premium

Rev. 0215

If you elect one of the increasing income options your initial income will be lower than shown in Table 1; however it will increase by 2.5% on each Policy anniversary after the rider has been in the Withdrawal Period for one year. Guaranteed Withdrawal Payments under the increasing options will cease to increase once the Accumulation Value is zero.

Increasing Income Option - not available in all states

Election at age 60 Election at age 65 Election at age 70Issue Annual GWP Annual GWP Annual GWPAge Current Mid-Range Guaranteed Current Mid-Range Guaranteed Current Mid-Range Guaranteed

25-40 1,857 1,663 1,341 2,089 1,871 1,509 2,322 2,079 1,67741 1,705 1,537 1,255 2,089 1,871 1,509 2,322 2,079 1,67742 1,562 1,417 1,171 2,089 1,871 1,509 2,322 2,079 1,67743 1,427 1,302 1,089 2,089 1,871 1,509 2,322 2,079 1,67744 1,299 1,193 1,010 2,089 1,871 1,509 2,322 2,079 1,67745 1,174 1,085 929 2,089 1,871 1,509 2,322 2,079 1,67746 1,056 982 850 1,919 1,729 1,412 2,322 2,079 1,67747 945 883 773 1,757 1,594 1,317 2,322 2,079 1,67748 840 790 698 1,605 1,465 1,226 2,322 2,079 1,67749 741 700 626 1,462 1,343 1,137 2,322 2,079 1,67750 653 620 560 1,321 1,221 1,045 2,322 2,079 1,67751 569 544 497 1,189 1,104 956 2,132 1,921 1,56952 490 471 435 1,063 994 870 1,953 1,771 1,46453 415 401 374 945 888 786 1,784 1,628 1,36254 345 335 316 834 788 704 1,624 1,492 1,26355 279 272 259 734 698 631 1,468 1,356 1,161

Sign and Submit with Application Page 3 of 3Form No. 11529

Date

Agent SignaturePrint Agent Name Agent Number Date

Print Applicant Name Applicant Signature

My signature as Applicant acknowledges that I have read and the agent has explained the contents of this Disclosure. I understand that I am applying for an annuity that may credit interest based on a formula that considers the change in the value of an external equity index. I understand that my Policy values will not participate in any equity market. My acceptance of the Guaranteed Lifetime Income Rider is shown on the application. I understand this original Disclosure will be enclosed with my application and a copy of it will be sent with my Policy.

Bonus Accumulation Value (BAV) - The BAV that will transfer tothe Accumulation Value if certain requirements are met. During Policy Years one through ten, the BAV is equal to 5% of the Accumulation Value. On Policy Date anniversaries 11 through 15, a portion of the BAV is transferred to the Premium Account if your annuity meets the Premium Test on the tenth policy anniversary and your annuity is in force on the transfer date. When a portion of the BAV is transferred, it becomes part of the Accumulation Value and is no longer part of the BAV. The Premium Test is met if either or both of the following two conditions are met: Total premiums paid less partial withdrawals taken is at least two times the total premiums paid in the first Policy Year, or Total premiums paid less partial withdrawals taken is greater than or equal to $20,000.

Declared Interest

Issue age limits for this annuity are owner/annuitant age 0-55 (0-54 in OH) Minimum Premium: Qualified - $100 per month salary reduction/deduction; Non-Qualified and IRA - $100 per month, automatic bank draft. Cumulative Maximum premium for Qualified Annuities: Issue ages 0-55 - $750,000. Annual premium limit for Non-Qualified Annuities: $25,000; Cumulative Maximum premium for Non-Qualified annuities: Issue ages 0-55 - $250,000. Qualified and Non-Qualified premium limits are per life and are subject to change. Refer to policy/endorsement for actual limits. Determination of Qualified and Non-Qualified status is made by Company. Transfer, rollover and exchange premiums may only be paid during the first five Policy Years into policies actively receiving flex premium. This annuity is designed for people who are willing to let their savings build for at least fifteen years.

S&P 500 Ending Index Russell 2000 Ending Index

SecurePlus Elite 5 is Policy Form 7967, 7968TX(0612), or state variation thereof.The Guaranteed Lifetime Income Rider is Rider Form 20135(0613), 20136(0613), 7964, 7966, or a state variation thereof.

The portion of the remaining BAV that is transferred to the Premium Account is as follows:

Policy Date anniversary

% of remaining BAV transferred

11

20%

15

100%

14

50%

13

331/3%

12

25%

Please understand that you have no right to or interest in the BAV unless and until it is transferred to the Accumulation Value. Withdrawals reduce the value of the BAV in the same proportion as the Accumulation Value is reduced.

Types of Interest Accounts that may be established on the 14th of each month:

Standard & Poor's, S&P, S&P 500, Standard & Poor's 500, and 500 are trademarks of The McGraw-Hill Companies, Inc. and have been licensed for use by Life Insurance Company of the Southwest. The product is not sponsored, endorsed, sold or promoted by Standard & Poor's and Standard & Poor's makes no representation regarding the advisability of purchasing the product. The Russell 2000 Index is a trademark of Russell Investment Group and has been licensed for use by Life Insurance Company of the Southwest. The product is not sponsored, endorsed, sold or promoted by Russell Investment Group and Russell Investment Group makes no representation regarding the advisability of purchasing the product.

Guaranteed Lifetime Income Rider Request and Understanding - Not Available in NJ, OR & WAIf indicated on the application that the Guaranteed Lifetime Income Rider ("Rider") will be issued with my Policy; I understand that the Rollup Rate, Guaranteed Withdrawal Percentages and Rider Charge Rates will be those in effect on the date the annuity is issued.Additional Rider DetailFlexible Premium Policies issued as a 403(b) or 457(b)

Rider Charge is 0.70% for all Policy Years Maximum Roll-up Rate period - 20 policy years

Flexible Premium Policies issued as any other qualification Rider Charge

Maximum Roll-up Rate period - 30 policy years

0.70% prior to the 21st Policy anniversary 0.80% on or after the 21st Policy anniversary At election of Guaranteed Withdrawal Payments, the Rider ChargeRate is the rate being applied at the time of election, whether 0.70% or 0.80%.

Withdrawal ChargesPolicy Year 1 2 3 4 5 6 7 8 9 10 11 13+12

Standard 12345678910 012 11

1403(b)/457(b) TX only 10 9 8 7 6 5 4 3 2 1 01

Rev. 0215

Kenneth R Pinkney 5500079429

Markita Tillmane-Signed by Kenneth R Pinkney

e-Signed by Markita Tillman

01/26/2016 15:45:01 GMT

01/26/2016 15:45:01 GMT

Owner's Name (First, Middle, Last) or Employer/Plan Name

Section 3 - Beneficiary (For Joint Owners, If an Owner dies the surviving Owner is the sole beneficiary. For qualified policies see the plan documents.)

Primary Beneficiary's Name (First, Middle, Last) Relation to Owner

SSN/TIN

M FGender

E-Mail AddressHome Address (Street - No PO Boxes, City, State, Zip)

Phone Number

Section 2 - Annuitant/Participant (if different than Owner)

Annuitant's Name (First, Middle, Last)

SSN/TIN

[Product Name] Individual Deferred Annuity Application

ICC13-11374(0913) Page 1 of 2 Cat. No. 101914

Section 1 - Owner

Phone Number

Phone Number

National Life Group is a trade name of National Life Insurance Company, Montpelier, VT, Life Insurance Company of the Southwest (LSW), Addison, TX and their affiliates. Each company of National Life Group is solely responsible for its own financial condition and contractual obligations. LSW is not an authorized insurer in New York and does not conduct insurance business in New York.P: 800-732-8939 F: 214-638-9162 [email protected] www.NationalLifeGroup.comCentralized Mailing Address: One National Life Drive, Montpelier, VT 05604-5555

GenderM F

DOB (mm/dd/yyyy) Country of Citizenship

Country of Citizenship

Country of Citizenship

SSN/TIN Share (%)

Contingent Beneficiary's Name (First, Middle, Last) Relation to Owner SSN/TIN Share (%)

Contingent Beneficiary's Name (First, Middle, Last) Relation to Owner SSN/TIN Share (%)

Primary Beneficiary's Name (First, Middle, Last) Relation to Owner SSN/TIN Share (%)

Joint Owner's Name (First, Middle, Last) (If applicable, for NQ only)

Relation to Owner

Relation to Owner

DOB (mm/dd/yyyy)

U.S. CitizenY N

DOB (mm/dd/yyyy)

DOB (mm/dd/yyyy)

DOB (mm/dd/yyyy)

DOB (mm/dd/yyyy)

DOB (mm/dd/yyyy)

GenderM F

U.S. CitizenY N

SSN/TIN

Section 4 - Plan Qualification

ROTH 457(b)457(b)ROTH 403(b)403(b) Pension/Profit Sharing 412(i) Other (specify)

IRA ROTH IRA Non-Qualified Other (specify)4a.

4b.Employer/District: School/Campus Name:

Section 5 - Premium Payment

Periodic Premium Amount: $ Start DateSemi-AnnuallyQuarterlyMonthlyBi-Weekly OtherFrequency?:

Salary Reduction Only: Please indicate any skip months below if any are scheduled within the next 12 months: Jan DecNovOctSepAugJulJunMayAprMarFeb

Single Premium:

Salary Reduction/Deduction or PAC (Section 5c is required for PAC)

(Approx)Transfer/Exchange/Direct Rollover $ Check $5a.

Bank Information5c.

5b.

Checking SavingsBank Acct. # Routing #Bank Name

U.S. CitizenY N

Guaranteed Lifetime Income Rider A signed Rider Disclosure Form is requiredSection 6 - Available Rider(s) (Please check for availability/Could be required in certain cases)

E-Mail AddressHome Address (Street - No PO Boxes, City, State, Zip)

The selected Insurer above is hereafter known as "the Company"

If more space is needed, attach Supplemental Information ICC13-20140(1113)

Alien Registration #



0

$125.00 03/15/2016

X

X

7425 LA VISTA DR APT 1723, DALLAS, TX 75214-4447

02/28/1987

[email protected]

Markita Tillman (972)489-0529

302-90-0400

Dallas ISD Billy Dade

02/12/1955

02/11/1954

Teressa Tillman

Mark Tillman

50

50

Mother

Father

X

X

403 (b) TSA

LSW SecurePlus Elite 5

eApp

X

PercentAgent No.Phone NumberOther Agent Name (print)

Other Agent Name (print) Phone Number Agent No. Percent

Signature of Primary Agent Agent E-Mail

ICC13-11374(0913) Page 2 of 2

Section 7 - Premium Allocation (Whole percentages only, must total 100%.)

Section 8 - Replacement

Section 9 - For Home Office Endorsement Only

Do you have an existing life insurance or annuity policy with us or any other company?

Regardless of the answers to the above questions, please refer to 2630-Required States Forms to determine the additional form(s) that may be required.

Will the proposed contract replace or change any existing annuity contract or life insurance policy?(If answered "Yes" in a NAIC state, a completed and signed NAIC Form A (8027) is required.)

(If answered "Yes", list the insurance company name(s) and policy or contract number(s) below. A state specific replacement form may also be required.)

Yes No

Yes No

Company NameContract/Policy No.Company NameContract/Policy No.

Section 10 - Notices/Acknowledgments

Section 11 - Agent Section

Section 12 - Commission (Please Note: If an Option is not selected, standard commissions will apply.)

Notice: Any person who knowingly presents a false statement in an application for insurance may be guilty of criminal offense and subject to penalties under state law.

Signed Date (mm/dd/yyyy)Signed at City and State

Signature of Owner

Is a replacement involved in this transaction?

Option BOption A (standard) Option C Other (specify)

Yes No

Primary Agent Name (print) Phone Number Agent No. Percent

Acknowledgments: The Annuitant and the Owner, if other than the Annuitant; (1) represents, to the best of their knowledge and belief, that all statements and answers contained herein are full, complete and true as written and are correctly recorded; and, (2) expressly agrees as follows: 1. This application and the answers and agreements contained herein shall be the basis of, a part of the consideration for, and a part of the annuity hereby applied for. 2. The payment of premium is consideration to the Company for the granting of an annuity and upon payment becomes the property of the Company. 3. I authorize my employer, if applicable, to withhold the premium to purchase the annuity for which I have applied. I authorize the Company to accept premiums on my behalf. 4. If applicable, I hereby request and authorize the Company to draw upon the Financial Institution listed in Section 5c provided there are sufficient funds in said account. This authorization shall remain in effect until revoked in writing by me, and received by the Company. I agree that the Company shall be fully protected in honoring the information in Section 5c and that if the information is rejected by said Financial Institution, whether with or without cause and whether intentionally or inadvertently, the Company will be under no liability whatsoever even though such rejection results in forfeiture of insurance coverage. 5. The annuity is effective on the date the premium is received by the Company at its Office. The SecurePlus single premium deferred annuities shall take effect on the 7th, 14th, 21st or 28th of the month following or coincident with the date the premium is received by the Company in its Office. 6. The Company is authorized to amend this application by appropriate notation in Section 9 For Home Office Endorsement Only to correct errors or omissions. The acceptance of any annuity issued from this application is acceptance and ratification of the beneficiary designation, if any, in such annuity and of any amendments contemplated above except that no change shall be made in the plan of annuity or benefits without the written acceptance of the Owner. 7. If applicable, the undersigned Annuitant hereby adopts, subscribes and agrees to the terms of his/her Employers plan, as now in effect or hereafter modified, and further agrees to be bound by all actions taken by the representatives thereof pursuant to and in accordance with said plan. I have received a copy of all sales material including electronically presented material and understand that the results shown, other than the guaranteed minimum values, are not guarantees, promises or warranties. I have received a copy of the Privacy Notice.

I certify that only sales material approved by the Company was used and that originals or copies of all sales material used were left with the applicant. I have not made statements that differ from this material nor have I made any promises about the expected future values of this policy.

DateCapacity (i.e. Trustee, Power of Attorney, etc.)Other Required Signatures (i.e. Joint Owner, Power of Attorney, etc.)

Signature of Annuitant/Participant

Agency Name

[(005)] S&P 500 Average Index %[(003)] S&P 500 Ending Index %

[(XXX)] [Index Name] [Index Method] %

[(XXX)] [Index Name] [Index Method] %[(XXX)] [Index Name] [Index Method] %[(XXX)] [Index Name] [Index Method] %

[(007)] Declared Interest Account %

ATRS

[email protected]

5500079429 100 %(972) 289-1450Kenneth R Pinkney

Standard

X

X

007 - Declared Interest Account: 20 % 003 - S&P 500 Index Account: 40 % 009 - Russell 2000 Index Account:40 %

X


01/26/2016 15:45:01 GMTTX

e-Signed by Kenneth R Pinkney

01/26/2016 15:45:01 GMT

Annuitant's SSN or TIN:Annuitant's Name (First, Middle, Last):

Supplemental Information to the Application for Annuity

ICC13-20140(1113) Cat. No. 52413National Life Group is a trade name of National Life Insurance Company, Montpelier, VT, Life Insurance Company of the Southwest (LSW), Addison, TX and their affiliates. Each company of National Life Group is solely responsible for its own financial condition and contractual obligations. LSW is not an authorized insurer in New York and does not conduct insurance business in New York.P: 800-732-8939 F: 214-638-9162 [email protected] www.NationalLifeGroup.comCentralized Mailing Address: One National Life Drive, Montpelier, VT 05604-5555

The selected Insurer above is hereafter known as "the Company"

Signature of Agent:

onSigned at (City and State):

Signature of Owner (if different than Annuitant):

Signature of Joint Owner (if applicable):

Signature of Annuitant:

Give complete details of any answers from the application where details did not fit within the allocated space on the application. Include with the information below the application section as well as the applicable information related to that question. This Supplemental Information will be attached to and become part of the application for annuity.

Markita Tillman 302-90-0400

Annuitant/Participant Information: Preferred method of contact: Phone Best Number to Call: Home Promo Emails: I do not want to receive any promotional emails on additional products or services.

Employer Information: Occupation or Job Title: Teacher Is Employer a Public K-12 school in TX?: Yes State: TX

Premium Information: Payment Method: Salary Reduction/Deduction

Miscellaneous Information: Is any of the agents writing this business, a registered representative of Equity Services, Inc. (ESI)?: No

e-Signed by Markita Tillman01/26/2016 15:45:01 GMT

TX

e-Signed by Kenneth R Pinkney01/26/2016 15:45:01 GMT

X

Do

Not

Det

ach

UNIFORM DISCLOSURE NOTICE TO POTENTIAL PURCHASER OF 403(b)

ANNUITY CONTRACT THROUGH SALARY REDUCTION AGREEMENT

WITH EDUCATIONAL INSTITUTION

Section I (for All Annuity Contracts)

Name of Agent Offering the AnnuityContract for Sale:Address of Offering Agent:

Telephone Number of Offering Agent:

State License Number of OfferingAgent:State Agency Issuing the OfferingAgents License:SEC License or Registration Number ofOffering Agent (if applicable):Name of Insurance Agency:

Address of Insurance Agency:

Telephone Number of InsuranceAgency:State License Number of InsuranceAgency:State Agency Issuing the InsuranceAgencys License:Name of Insurer:

Address of Insurer:

Telephone Number of Insurer:

Name of Insurers AccountRepresentative Authorized to Respondto Inquiries or Complaints:

Texas Department of Insurance

Life Insurance Company of the Southwest

15455 Dallas ParkwaySte. 800Addison, TX 75001

(214) 638-7100

Sandy Mollett, Director of Market Conduct andCompliance

N/A

Form No. 10834TX(1212) Page 1 of 5 LR11718(0112); Cat. No. 101692

ATRS

Kenneth R Pinkney

(972) 289-1450

674215

(972) 289-1450

Texas Department of Insurance

674215

Do N

ot Detach

Address of Insurers AccountRepresentative:

Telephone Number of InsurersAccount Representative:FAX Number of Insurers AccountRepresentative:

Section II (for Fixed Annuity Contracts, and Variable Annuity Contracts as Applicable)

Product Name:

Current Interest Rate or the FormulaUsed to Calculate the Current Rate ofInterest:

Guaranteed Rate of Interest andPercentage of the Premium to Which theInterest Rate Applies:

How Interest is Compounded:

Amount of any Fees, Costs, or PenaltiesUp-Front Charges, such as Front-EndSales Load:

Surrender Charges:

SecurePlus Elite 5

Different rates and formulas apply to each of the accountswithin the Accumulation Value, namely, the PremiumAccount, the Declared Interest Accounts, and the IndexedInterest Accounts.*

The guaranteed minimum annual effective interest rate is 1%and applies to 90% of the premium. This guaranteedminimum value is the Policy Value.

Interest compounds daily for the Premium Account, theDeclared Interest Accounts, and the Policy Value. Interestcompounds annually for the Indexed Interest Accounts.

None

See Withdrawal Charges.

See Withdrawal Charges.

15455 Dallas ParkwaySte. 800Addison, TX 75001

(214) 638-9347

(214) 638-7100


Do

Not

Det

ach

Withdrawal Charges:

Deferred Sales Charges, such as Back-End Sales Load:

Market Value Adjustment Charges:

Loan Initiation Fee:

Amount of Any Other Fees, Costs orPenalties:

Any Other Contract Restrictions thatExceed 10 Years:

How long the annuity is required to be inforce before the purchaser is entitled tothe full bonus accumulation value:

The manner in which the amount of theguaranteed benefit under the annuity iscomputed:

Are loans guaranteed to be availableunder the annuity:

Yes No

AnnuityYear 1 2 3 4 5 6 7 8 9 10 11 12 13+With.Charge 10% 9% 8% 7% 6% 5% 4% 3% 2% 1% 1% 1% 0%See Withdrawal Charges.

None

None

None

Withdrawal Charges applicable in years eleven and twelve.

The annuity must be in force until the 15th Policy Dateanniversary to be entitled to the full bonus accumulationvalue.

The guaranteed minimum settlement options are based oninterest guaranteed at a 1% annual effective rate and thea2000 Individual Annuity Mortality Table blended for unisexuse at 40% male and 60% female.

Subject to strict IRS, Co. and yourPlan rules.


Do N

ot Detach

What restrictions, if any, apply to theavailability of money attributable to thevalue of the annuity once the purchaser isretired or separated from the employmentof the employer:

Does the annuity guarantee theparticipant the right to surrender apercentage of the surrender value eachyear, and the percentage, if any:

Yes NoGuaranteed Percentage: _____

Does the annuity guarantee the interestrate associated with any settlementoption:

Yes No

Section III (Relating to Variable and Equity-Based Index Annuity Contracts)

Article 6228a-5, Vernons Texas Civil Statutes, Section 11 provides the following:(a) A person who offers to sell an annuity contract that is or will likely be the subject of a

salary reduction agreement shall provide notice to a potential purchaser as provided bythis section:

(d) A variable annuity must be accompanied by:(1) a notice that includes any item listed in Subsection (c) of this section [Section II

of this form] that is applicable to variable annuities;(2) the prospectus; and(3) any other purchasing information required by law.

(e) An equity-based index contract must state in plain language how the annuity contract willbe credited with growth.

Section IV (for All Annuity Contracts)

The company offering this annuity must comply with the provisions of Section 5, Article 6228a-5,Vernons Texas Civil Statutes (V.T.C.S.) and 34 TAC, Chapter 53.

TRS may be contacted by phone at 800-223-8778 or the TRS Web site may be accessed atwww.trs.state.tx.us to determine which companies are in compliance with Section 5. Companies onthe TRS List of 403(b) Certified Companies have certified they are in compliance with Section 5,Article 6228a-5, V.T.C.S.

A school employee may use a salary reduction agreement to purchase any eligible qualifiedinvestment from any company shown on the TRS List of 403(b) Certified Companies.

Generally there are no restrictions to the availability of theCash Value if retired after attainment of age 55 or separatedfrom service.

10%After First Annuity Year

The interest rate reflected in theguaranteed settlement option is 1%


Do

Not

Det

ach

Civil remedies are available to a school employee under the Deceptive Trade Practices Act (Section17.49, Business & Commerce Code, V.T.C.S.) against a person for selling, offering to sell, orillegally promoting an annuity contract to the employee with the intent that it will be subject to asalary reduction agreement if the annuity is not an eligible qualified investment offered by acompany on the TRS List of 403(b) Certified Companies.

To inquire or file a complaint about the insurance agent or company, contact the ConsumerProtection Division of the Texas Department of Insurance at: Toll Free Number: 1-800-252-3439; In Austin, call: (512) 463-6515; Fax: 512-475-1771; Web site: www.tdi.state.tx.us

The Consumer Protection Division of the Texas Attorney Generals Office can be reached at: 1-800-337-3928 or 1-800-621-0508.

This disclosure notice has been explained to me by the agent named in Section I,and I understand that if the investment product related to this notice does not meetthe requirements of Texas law and TRS rules, that I have specific legal remedies.I also understand that I will be given a completed copy of this notice.

Signed: __________________________________ Date: ___________________Signature of Potential Purchaser

Signed: __________________________________ Date: ___________________Signature of Agent Shown in Section I

* On the day a premium is received, it is placed in the Premium Account. Once each month, all amountsin the Premium Account are transferred to the selected Interest Account(s). Each Interest Account ismaintained separately. Interest is credited daily to the Premium Account and the Declared InterestAccounts. Interest is credited annually to the Indexed Interest Accounts and is determined based, in part,on the Annual Percentage Change of either the Standard & Poors 500 Index or the Russell 2000 Index(Index Value). The Annual Percentage Change, calculated at the end of each Account Year, is thepercentage change from the Index Value at the beginning of the Account Year to the Index Value at theend of the Account Year. The interest rate credited to an Indexed Interest Account is the Index Ratemultiplied by the Annual Percentage Change, subject to a Floor and a Cap. The rates for each InterestAccount are set in advance at the beginning of the Account Year, and the rates are guaranteed for theAccount Year.


e-Signed by Markita Tillman 01/26/2016 15:45:01 GMT

e-Signed by Kenneth R Pinkney 01/26/2016 15:45:01 GMT

Centralized Mailing Address: One National Life Drive, Montpelier, VT 05604 | www.NationalLifeGroup.com

National Life Group is a trade name of National Life Insurance Company, Montpelier, VT, Life Insurance Company of the Southwest (LSW), Addison, TX and their affiliates. Each company of National Life Group is solely responsible for its own financial condition and contractual obligations. LSW is not an authorized insurer in New York and does not conduct insurance business in New York.

20243(0314) Cat. No. 52505

eSignature

Application Date:

Proposed Insured / Annuitant:

Transaction ID:

Consent to Do Business Electronically

What is the purpose of this Consent? If you continue with this electronic application for a life insurance policy or annuity contract issued by National Life Insurance Company or Life Insurance Company of the Southwest (we, us, our), you are expressing your desire to conduct business electronically with us. To conduct business electronically, you may be required to provide us, and our authorized designees and agents, with your consent and your e-mail address. By continuing with this electronic application, you will be providing us and our authorized designees and agents with your consent to conduct this transaction electronically and to all of the terms and conditions of this consent.

This consent covers your agreement to be bound with the same force and effect as if you had signed your name on paper by hand. You understand that by continuing with this electronic application that you are giving your electronic signature to your request. You agree to maintain the security of your Internet access and e-mail address.

What kinds of transactions may be conducted electronically?Currently, the only transaction that may be conducted electronically is the application for a life insurance policy or an annuity contract, and electronic delivery of certain notices, disclosures and our privacy policy provided in connection with your application. Even though you have provided us with this consent, we may, at our option: (a) deliver documents and information to you on paper, and (b) require that certain communications from you be delivered to us on paper.

If I prefer to use paper instead of conducting a transaction electronically, may I use paper?Yes. If you do not wish to apply for life insurance electronically, please do not proceed with this electronic application and ask your agent to provide you a paper application.

How long will this consent remain in effect? This consent shall become effective as soon as you click I AGREE below and remains in effect throughout the purchase transaction. This consent does not apply to any future transactions with us.

What if I change my mind?If you change your mind about applying electronically, you should not proceed with an electronic application. Instead, ask your agent to provide you a paper application.

What if my e-mail changes?If your e-mail changes after you have provided it to your agent but before you have electronically signed your application, please let your agent know right away.

Name:

Date and Time eSigned: eSignature Method:

Role:

IP Address:

Signature:

12.186.51.194, 96.17.163.165, 208.185.5

965404X

Face to Face

Markita Tillman

Markita Tillman


01/26/2016 15:45:01 GMT

01/26/2016 15:45:01 GMT

Annuitant

X

Centralized Mailing Address: One National Life Drive, Montpelier, VT 05604 | www.NationalLifeGroup.com

National Life Group is a trade name of National Life Insurance Company, Montpelier, VT, Life Insurance Company of the Southwest (LSW), Addison, TX and their affiliates. Each company of National Life Group is solely responsible for its own financial condition and contractual obligations. LSW is not an authorized insurer in New York and does not conduct insurance business in New York.

20243(0314) Cat. No. 52505

eSignature

Application Date:

Proposed Insured / Annuitant:

Transaction ID:

Consent to Do Business Electronically

What is the purpose of this Consent? If you continue with this electronic application for a life insurance policy or annuity contract issued by National Life Insurance Company or Life Insurance Company of the Southwest (we, us, our), you are expressing your desire to conduct business electronically with us. To conduct business electronically, you may be required to provide us, and our authorized designees and agents, with your consent and your e-mail address. By continuing with this electronic application, you will be providing us and our authorized designees and agents with your consent to conduct this transaction electronically and to all of the terms and conditions of this consent.

This consent covers your agreement to be bound with the same force and effect as if you had signed your name on paper by hand. You understand that by continuing with this electronic application that you are giving your electronic signature to your request. You agree to maintain the security of your Internet access and e-mail address.

What kinds of transactions may be conducted electronically?Currently, the only transaction that may be conducted electronically is the application for a life insurance policy or an annuity contract, and electronic delivery of certain notices, disclosures and our privacy policy provided in connection with your application. Even though you have provided us with this consent, we may, at our option: (a) deliver documents and information to you on paper, and (b) require that certain communications from you be delivered to us on paper.

If I prefer to use paper instead of conducting a transaction electronically, may I use paper?Yes. If you do not wish to apply for life insurance electronically, please do not proceed with this electronic application and ask your agent to provide you a paper application.

How long will this consent remain in effect? This consent shall become effective as soon as you click I AGREE below and remains in effect throughout the purchase transaction. This consent does not apply to any future transactions with us.

What if I change my mind?If you change your mind about applying electronically, you should not proceed with an electronic application. Instead, ask your agent to provide you a paper application.

What if my e-mail changes?If your e-mail changes after you have provided it to your agent but before you have electronically signed your application, please let your agent know right away.

Name:

Date and Time eSigned: eSignature Method:

Role:

IP Address:

Signature:

Agent

Kenneth R Pinkney

12.186.51.194, 96.17.163.165, 208.185.

965404X

Face to Face

Markita Tillman

e-Signed by Kenneth R Pinkney

01/26/2016 15:45:01 GMT

01/26/2016 15:45:01 GMT

Agent

X

Confidentialityof informationfor victims ofdomesticviolence orabuse

The Companies have established policies and procedures to safeguard personal information, includingcontact, location or other confidential abuse information, for victims of domestic abuse and childrenresiding with those victims. A protected person is a victim of domestic violence or abuse who notifiesthe Companies and requests confidential treatment of their personal information.

If you wish to be a protected person or otherwise request confidential treatment of your information orthat of your children and/or provide alternative contact information, please send your written request tothe address listed below.

Otherimportantinformation

You have certain rights to access the personal information we maintain about you if it is reasonablylocatable and retrievable.

To obtain your personal information, submit a written request to the email or mail address below. Youhave certain rights to correct, amend, or delete information we maintain about you.

To correct, amend, or delete information we maintain about you, submit a written request to the emailor mail address below.

If we agree to your request, we will correct, amend, or delete your information as applicable andnotify affected parties as required by law.

If we do not agree to your request, you may file a concise statement regarding your information,which will be provided to affected parties as required by law.

Before we disclose information about your creditworthiness or your personal information other thanas discussed above (which we do not currently do) we will provide you the opportunity to opt out ofsuch disclosures.

Finally, information obtained from a report prepared by an insurance-support organization may beretained by the insurance-support organization and disclosed to other persons.

Questions? For more information, please contact us at

Email: [email protected] Phone: 800-732-8939 Mail: National Life Group

Market Conduct and Compliance M530 One National Life DriveMontpelier, VT 05604

*Sentinel Investments is the unifying brand name for Sentinel Financial Services Company, Sentinel Asset Management, Inc., and Sentinel

Administrative Services, Inc.

9314(0713) Page 2 of 2

20209(1013)

Buyers Guide forDeferred Annuities Fixed

Prepared by the

NAIC

National Association of Insurance Commissioners

The National Association of Insurance Commissioners is an associationof state insurance regulatory officials. This association helps the various insurance departments to coordinate

insurance laws for the benefit of all consumers.

This guide does not endorse any company or policy.

Reprinted by

National Life Insurance Company

And

Life Insurance Company of the Southwest

20209(1013)

NAIC Buyers Guide for Fixed Deferred Annuities

Its important that you understand how annuities can be different from each other so you can choose the type ofannuity thats best for you. The purpose of this Buyers Guide is to help you do that. This Buyers Guide isntmeant to offer legal, financial, or tax advice. You may want to consult independent advisors that specialize inthese areas.

This Buyerss Guide is about fixed deferred annuities in general and some of their most common features. Itss notabout any particular annuity product. The annuity you select may have unique features this Guide doesntdescribe. Its important for you to carefully read the material youre given or ask your annuity salesperson,especially if youre interested in a particular annuity or specific annuity features.

This Buyers Guide includes questions you should ask the insurance company or the annuity salesperson (theagent, producer, broker, or advisor). Be sure youre satisfied with the answers before you buy an annuity.

Revised 2013

Copyright 1999, 2007, 2013 National Association of Insurance Commissioners. All rights reserved.

Printed in the United States of America

No part of this book may be reproduced, stored in a retrieval system, or transmittal in any form or by any means,electronic or mechanical, including photocopying, recording or any storage or retrieval system, without written

permission from the NAIC.

NAIC Executive Office NAIC Central Office NAIC Capital Markets &444 North Capitol Street, NW 1100 Walnut Street Investment Analysis OfficeSuite 701 Suite 1500 48 Wall Street, 6th FloorWashington, DC 20001-1509 Kansas City, MO 64106-2197 New York, NY 10005-2906202.471.3990 816.842.3600 212.398.9000

20209(1013)

Buyers Guide for Deferred Annuities - Fixed

Table of Contents

What Is an Annuity? 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

When Annuities Start to Make Income Payments 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

How Deferred Annuities Are Alike 1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

How Deferred Annuities Are Different 2. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

How Does the Value of a Deferred Annuity Change? 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Fixed Annuities 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Fixed Indexed Annuities 3. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

What Other Information Should You Consider? 4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Fees, Charges, and Adjustments 4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

How Annuities Make Payments 5. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

How Annuities Are Taxed 6. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Finding an Annuity Thats Right for You 6. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Questions You Should Ask 7. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

When You Receive Your Annuity Contract 7. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

______________________________________________1FINRA (Financial Industry Regulatory Authority) regulates the companies and salespeople who sell variableannuities.

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What is an Annuity?An annuity is a contract with an insurance company. All annuities have one feature in common, and it makesannuities different from other financial products. With an annuity, the insurance company promises to pay youincome on a regular basis for a period of time you choose - including the rest of your life.

When Annuities Start to Make Income PaymentsSome annuities begin paying income to you soon after you buy it (an iimmediate annuity). Others begin at somelater date you choose (a ddeferred annuity).

How Deferred Annuities Are AlikeThere are ways that most deferred annuities are alike.

They have an aaccumulation period and a ppayout period. During the accumulation period, the value ofyour annuity changes based on the type of annuity. During the payout period, the annuity makesincome payments to you.

They offer a basic death benefit. If you die during the accumulation period, a deferred annuity with abasic death benefit pays some or all of the annuitys value to your survivors (called beneficiaries) eitherin one payment or multiple payments over time. The amount is usually the greater of the annuityaccount value or the minimum guaranteed surrender value. If you die after you begin to receive incomepayments (aannuitize), your chosen survivors may not receive anything unless: 1) your annuityguarantees to pay out at least as much as you paid into the annuity, or 2) you chose a payout optionthat continues to make payments after your death. For an extra cost, you may be able to chooseenhanced death benefits that increase the value of the basic death benefit.

You usually have to pay a charge (called a ssurrender or wwithdrawal charge) if you take some or all ofyour money out too early (usually before a set time period ends). Some annuities may not charge if youwithdraw small amounts (for example, 10% or less of the account value) each year.

Any money your annuity earns is ttax deferred. That means you wont pay income tax on earnings untilyou take them out of the annuity.

You can add features (called rriders) to many annuities, usually at an extra cost.

An annuity salesperson must be licensed by your state insurance department. A person selling a variableannuity also must be registered with FINRA1 as a representative of a broker/dealer thats a FINRAmember. In some states, the state securities department also must license a person selling a variableannuity.

Insurance companies sell annuities. You want to buy from an insurance company thats financiallysound. There are various ways you can research an insurance companys financial strength. You canvisit the insurance companys website or ask your annuity salesperson for more information. You alsocan review an insurance companys rating from an independent rating agency. Four main firmscurrently rate insurance companies. They are A.M. Best Company, Standard and Poors Corporation,Moodys Investors Service, and Fitch Ratings. Your insurance department may have more informationabout insurance companies. An easy way to find contact information for your insurance department isto visit www.naic.org and click on States and Jurisdictions Map.

Insurance companies usually pay the annuity salesperson after the sale, but the payment doesnt reducethe amount you pay into the annuity. You can ask your salesperson how they earn money from the sale.

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Sources of Information

Contract: The legal document between you and the insurance company that binds both of you to the terms ofthe agreement.

Disclosure: A document that describes the key features of your annuity, including what is guaranteed and whatisnt, and your annuitys fees and charges. If you buy a variable annuity, youll receive a prospectus thatincludes detailed information about investment objectives, risks, charges, and expenses.

Illustration: A personalized document that shows how your annuity features might work. Ask what isguaranteed and what isnt and what assumptions were made to create the illustration.

How Deferred Annuities Are DifferentThere are differences among deferred annuities. Some of the differences are:

Whether you pay for the annuity with one or more than one payment (called a ppremium).

The types and amounts of the ffees, ccharges, and aadjustments. While almost all annuities have some feesand charges that could reduce your account value, the types and amounts can be different amongannuities. Read the Fees, Charges, and Adjustments section in this Buyers Guide for moreinformation.

Whether the annuity is a ffixed annuity or a vvariable annuity. How the value of an annuity changes isdifferent depending on whether the annuity is fixed or variable.

Fixed annuities guarantee your money will earn at least a minimum interst rate. Fixed annuitiesmay earn interest at a rate higher than the minimum but only the minimum rate is guaranteed. Theinsurance company sets the rates.

Fixed indexed annuities are a type of fixed annuity that earns interest based on changes in a marketindex, which measures how the market or part of the market performs. The interest rate isguaranteed to never be less than zero, even if the market goes down.

Variable annuities earn investment returns based on the performance of the investment portfolios,known as subaccounts, where you choose to put your money. The return earned in a variableannuity isnt guarnteed. The value of the subaccounts you choose could go up or down. If they goup, you could make money. But, if the value of these subaccounts goes down, you could losemoney. Also, income payments to you could be less than you expected.

Some annuities offer a ppremium bonus, which usually is a lump sum amount the insurance companyadds to your annuity when you buy it or when you add money. Its usually a set percentage of theamount you put into the annuity. Other annuities offer an iinterest bonus, which is an amount theinsurance company adds to your annuity when you earn interest. Its usually a set percentage of theinterest earned. You may not be able to withdraw some or all of your premium bonus for a set periodof time. Also, you could lose the bonus if you take some or all of the money out of your annuity withina set period of time.

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How Does the Value of a Deferred Annuity Change?Fixed Annuities

Money in a fixed deferred annuity earns interest at a rate the insurer sets. The rate is ffixed (wont change) forsome period, usually a year. After that rate period ends, the insurance company will set another fixed interest ratefor the next rate period. That rate could be higher or lower than the earlier rate.

Fixed deferred annuities do have a guaranteed minimum interest rate - the lowest rate the annuity can earn. Itsstated in your contract and disclosure and cant change as long as you own the annuity. Ask about:

The initial interest rate - What is the rate? How long until it will change?

The renewal interest rate - When will it be announced? How will the insurance company tell you whatthe new rate will be?

Fixed Deferred Indexed Formulas

Annual Point-to-Point - Change in index calculated using two dates one year apart.

Multi-Year Point-to-Point - Change in index calculated using two dates more than one year apart.

Monthly or Daily Averaging - Change in index calculated using multiple dates (one day of every month formonthly averaging, every day the market is open for daily averaging). The average of these values is comparedwith the index value at the start of the index term.

Monthly Point-to-Point - Change in index calculated for each month during the index term. Each monthlychange is limited to the cap rate for positive changes, but not when the change is negative. At the end of theindex term, all monthly changes (positive and negative) are added. If the result is positive, interest is added tothe annuity. If the result is negative or zero, not interest (0%) is added.

Fixed Indexed Annuities

Money in a fixed indexed annuity earns interest based on changes in an index. Some indexes are measures of howthe overall financial markets perform (such as the S&P 500 Index or Dow Jones Industrial Average) during a setperiod of time (called the iindex term). Others measure how a specific financial market performs (such as theNasdaq) during the term. The insurance company uses a formula to determine how a change in the index affectsthe amount of interest to add to your annuity at the end of each index term. Once interest is added to yourannuity for an index term, those earnings usually are locked in and changes in the index in the next index termdont affect them. If you take money from an indexed annuity before an index term ends, the annuity may not addall of the index-linked interest for that term to your account.

Insurance companies use different formulas to calculate the interest to add to your annuity. They look at changesin the index over a period of time. See the box Fixed Deferred Indexed Formulas that describes how changes in anindex are used to calculate interest.

The formulas insurance companies use often mean that interest added to you annuity is based on only part of achange in an index over a set period of time. PParticipation rates, cap rates, and sspread rates (sometimes calledmargin or asset fees) all are terms that describe ways the amount of interest added to your annuity may not reflectthe full change in the index. But if the index goes down over that period, zero interest is added to your annuity.Then your annuity value wont go down as long as you dont withdraw the money.

When you buy an indexed annuity, you arent investing directly in the market or the index. Some indexedannuities offer you more than one index choice. Many indexed annuities also offer the choice to put part of yourmoney in a fixed interest rate account, with a rate that wont change for a set period.

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How Insurers Determine Indexed Interest

Participation Rate - Determines how much of the increase in the index is used to calculate index-linked interest.A participation rate usually is for a set period. The period can be from one year to the entire term. Somecompanies guarantee the rate can never be lower (higher) than a set minimum (maximum). Participation ratesare often less than 100%, particularly when theres no cap rate.

Cap Rate - Typically, the maximum rate of interest the annuity will earn during the index term. Some annuitiesguarantee that the cap rate will never be lower (higher) than a set minimum (maximum). Companies often use acap rate, especially if the participation rate is 100%.

Spread Rate - A set percentage the insurer subtracts from any change in the index. Also called a margin or assetfee. Companies may use this instead of or in addition to a participation or cap rate.

What Other Information Should You Consider?

Fees, Charges and Adjustments

Fees and charges reduce the value of your annuity. They help cover the insurers costs to sell and manage theannuity and pay benefits. The insurer may subtract these costs directly from your annuitys value. Most annuitieshave fees and charges but they can be different for different annuities. Read the contract and disclosure orprospectus carefully and ask the annuity salesperson to describe these costs.

A ssurrender or wwithdrawal charge is a charge if you take part or all of the money out of your annuity during a setperiod of time. The charge is a percentage of the amount you take out of the annuity. The percentage usually goesdown each year until the surrender charge period ends. Look at the contract and the disclosure or prospectus fordetails about the charge. Also look for any waivers for events (such as a death) or the right to take out a smallamount (usually up to 10%) each year without paying the charge. If you take all of your money out of an annuity,youve surrendered it and no longer have any right to future income payments.

Some annuities have a MMarket Value Adjustment (MVA). An MVA could increase or decrease your annuitysaccount value, cash surrender value, and/or death benefit value if you withdraw money from your account. Ingeneral, if interest rates are lower when you withdraw money than they were when you bought the annuity, theMVA could increase the amount you could take from your annuity. If interest rates are higher than when youbought the annuity, the MVA could reduce the amount you could take from your annuity. Every MVAcalculation is different. Check your contract and disclosure or prospectus for details.

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Annuity Fees and Charges

Contract fee - A flat dollar amount or percentage charged once or annually.

Percentage of purchase payment - A front-end sales load or other charge deducted from each premium paid.The percentage may vary over time.

Premium tax - A tax some states charge on annuities. The insurer may subtract the amount of the tax when youpay your premium, when you withdraw your contract value, when you start to receive income payments, orwhen it pays a death benefit to your beneficiary.

Transaction fee - A charge for certain transactions, such as transfers or withdrawals.

* * *

Mortality and expense (M&E) risk charge - A fee charged on variable annuities. Its a percentage of theaccount value invested in subaccounts.

Underlying fund charges - Fees and charges on a variable annuitys subaccounts; may include an investmentmanagement fee, distribution and service (12b-l) fees, and other fees.

How Annuities Make Payments

Annuitize

At some future time, you can choose to aannuitize your annuity and start to receive guaranteed fixed incomepayments for life or a period of time you choose. After payments begin, you cant take any other money out of theannuity. You also usually cant change the amount of your payments. For more information, see Payout Optionsin this Buyers Guide. If you die before the payment period ends, your survivors may not receive any payments,depending on the payout option you choose.

Full Withdrawal

You can withdraw the cash surrender value of the annuity in a lump sum payment and end your annuity. Youlllikely pay a charge to do this if its during the surrender charge period. If you withdraw your annuitys cashsurrender value, your annuity is cancelled. Once that happens, you cant start or continue to receive regularincome payments from the annuity.

Partial Withdrawal

You may be able to withdraw some of the money from the annuitys cash surrender value without ending theannuity. Most annuities with surrender charges let you take out a certain amount (usually up to 10%) each yearwithout paying surrender charges on that amount. Check your contract and disclosure or prospectus. Ask yourannuity salesperson about other ways you can take money from the annuity without paying charges.

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Living Benefits for Fixed Annuities

Some fixed annuities, especially fixed indexed annuities, offer a gguaranteed living benefits rider, usually at anextra cost. A common type is called a guaranteed lifetime withdrawal benefit that guarantees to make incomepayments you cant outlive. While you get payments, the money still in your annuity continues to earn interest.You can choose to stop and restart the payments or you might be able to take extra money from your annuity.Even if the payments reduce the annuitys value to zero at some point, youll continue to get payments for the restof your life. If you die while receiving payments, your survivors may get some or all of the money left in yourannuity.

Payout Options

Youll have a choice about how to receive income payments. These choices usually include:

For your lifetime

For the longer of your lifetime or your spouses lifetime

For a set time period

For the longer of your lifetime or a set time period

How Annuities Are Taxed

Ask a tax professional about your individual situation. The information below is general and should not beconsidered tax advice.

Current federal law gives annuities special tax treatment. Income tax on annuities is deferred. That means youarent taxed on any interest or investment returns while your money is in the annuity. This isnt the same astax-free. Youll pay ordinary income tax when you take a withdrawal, receive an income stream, or receive eachannuity payment. When you die, your survivors will typically owe income taxes on any death benefit they receivefrom an annuity.

There are other ways to save that offer tax advantages, including Individual Retirement Accounts (IRAs). You canbuy an annuity to fund an IRA, but you also can fund your IRA other ways and get the same tax advantages.When you take a withdrawal or receive payments, youll pay ordinary income tax on all of the money you receive(not just the interest or the investment return). You also may have to pay a 10% tax penalty if you withdrawmoney before youre age 59.

Finding an Annuity Thats Right for You

An annuity salesperson who suggests an annuity must choose one that they think is right for you, based oninformation from you. They need complete information about your life and financial situation to make a suitablerecommendation. Expect a salesperson to ask about your age; your financial situation (assets, debts, income, taxstatus, how you plan to pay for the annuity); your tolerance for risk; your financial objectives and experience;your family circumstances; and how you plan to use the annuity. If you arent comfortable with the annuity, askyour annuity salesperson to explain why they recommended it. Dont buy an annuity you dont understand or thatdoesnt seem right for you.

Within each annuity, the insurer may guarantee some values but not others. Some guarantees may be only for ayear or less while others could be longer. Ask about risks and decide if you can accept them. For example, itspossible you wont get all of your money back or the return on your annuity may be lower than you expected. Itsalso possible you wont be able to withdraw money you need from your annuity without paying fees or theannuit

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