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Current informationPrint insured‘s name DOB Gender

Additional insured‘s name DOB Gender

Policyowner (if different than insured)

Policyowner’s phone Policyowner’s e-mail address

Beneficiary information Original underwriting class — any health changes since issue

Purpose for insurance (survivor needs, cover estate taxes, business planning, retirement income, etc.)

Policy informationPolicy number Policy date Policy type

Insurance company name Benefit amount

Original purpose of insurance

Does purpose still exist? Has it changed? If so, explain.

Policy designPremium amount Frequency Number of years

Current interest rate Guaranteed interest rate

Option (increasing, level, face + premiums)

Riders

Current cash value Net cash surrender value Cost basis

Any loans? Please include amount, interest rate, status, and plans for payback (if any).

F O R L I F E

Policy Review evaluation worksheetData Form — one per policy

2061214

Products issued by:The Lincoln National Life Insurance CompanyLincoln Life & Annuity Company of New York

Fax: 866-271-8172Email: tav@tavgroup.net

In-force illustration requirements Same premium and benefit amount at current interest rate

Same premium and benefit amount at % assumed interest rate

Solve to pay premiums for years to attain $ cash value at maturity

Other

ConsiderationsHow long will you require a death benefit?

Age Age 100 Beyond age 100 Other

How many years do you plan to pay premiums?

1 year 5 years 10 years 20 years All years Other

Prioritize objectives — Rank from 1 to 3, 1 being most important. Use each number only once.

I want to accumulate money for later to withdraw supplemental retirement income.

Accumulation is secondary; I want the death benefit guaranteed.

I want to pay the lowest premium and am less concerned about returns and guarantees.

Have there been any changes in your life goals since you first purchased this insurance?

Notes

Not a deposit

Not FDIC-insured

Not insured by any federal government agency

Not guaranteed by any bank or savings association

May go down in value

©2012 Lincoln National Corporation

Visit LincolnFinancial.com

Lincoln Financial Group is the marketing name for Lincoln National Corporation and its affiliates.

Affiliates are separately responsible for their own financial and contractual obligations.

LCN1111-2061214 PDF 8/12 Z02 Order code: LIF-PR-FLI002

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Lincoln life insurance policies are issued by The Lincoln National Life Insurance Company, Fort Wayne, IN, and distributed by Lincoln Financial Distributors, Inc., a broker/dealer. The Lincoln National Life Insurance Company does not solicit business in the state of New York, nor is it authorized to do so.

Policies sold in New York are issued by Lincoln Life & Annuity Company of New York, Syracuse, NY, and distributed by Lincoln Financial Distributors, Inc., a broker/dealer.

All guarantees and benefits of the insurance policy are backed by the claims-paying ability of the issuing insurance company. They are not backed by the broker/dealer and/or insurance agency selling the policy, or any affiliates of those entities other than the issuing company affiliates, and none makes any representations or guarantees regarding the claims-paying ability of the issuer.

Products and features are subject to state availability. Limitations and exclusions may apply.

Fax: 866-271-8172Email: tav@tavgroup.net

SERVICING AGENT REQUEST

Insurance Company Name :

Address:

Policy Number : Insured’s Name :

Policyowner’s Name : Policyowner’s SSN :

Name of New Servicing Agent : Agent’s SSN :

Attn: Policyholder Service Department

Please mark the above agent as my servicing agent. I would like this change to be effective immediately,

as I am working with my agent to ensure my coverage is meeting my needs. My servicing agent may

request inforce ledgers to evaluate my insurance with. I am requesting that you provide any information

concerning my insurance policy that is requested by my new servicing agent.

Policyowner’s Signature Date :

INFORCE ILLUSTRATION REQUEST

Insurance Company Name :

Address:

Policy Number : Insured’s Name :

Policyowner’s Name : Policyowner’s SSN :

Attn: Policyholder Service Department

Please generate the below requested illustrations so I may review my policy features with my agent. I have no intentions to sell my policy at this time. The purpose for this request is to evaluate past performace and expected future policy benefits. Specific request for how my inforce illustrations should be calculated are as follows.

Policyowner’s Signature Date :

Please return the illustration by fax to 866-271-8172. Thank you