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SERFF Tracking AFLC-129886036 State Tracking State District of Columbia TOI/Sub-TOI A10 Annuities - Other/A10. ANNUITANT Annuitant will be the Owner unless Owner section is completed. Last Name First Name Date of Birth // MM / DD / YYYY SSN or Tax I. JOINT ANNUITANT Not available for QLAC Joint Annuitant will be the joint owner unless Owner section is completed. Relationship to Annuitant 9. Schedule Supporting Document Schedule Item State Required Notice Platinum Provider Annuity Application...
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