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LINCOLN AMERICAN LEGACY RETIREMENTSM GVA



Plan Support Materials and Forms for the State of New York

Materials on this page:


Forms Participant Trustee TPA Agent
EM11137-DLN [Fillable] Blackout Notice and Instructions x x
EM-30060-LA-N Blanket Authorization x x x
EM91506-DLN Change of Beneficiary x x x x
EM-29735 Change of Personal Information x x x x
EM30007 [Fillable] Loan Default Request x x
ALR-50896 Promissory Note x x x x
EM27607-LDN-TB Request for Contract x x x
EM27607-LDN-TB [Fillable] Request for Contract x x x
EM28114-LDN-TB Request for Contract and Plan Services x x x
EM-29796 Third Party Administrator (TPA / Service Provider) Change Form
x x
ALR-50895 Truth in Lending x x x x

Hello future.
Lincoln Financial Group is the marketing name for Lincoln National Corporation and insurance
company affiliates, including The Lincoln National Life Insurance Company, Fort Wayne, IN,
and in New York, Lincoln Life & Annuity Company of New York, Syracuse, NY. Variable products
distributed by broker/dealer-affiliate Lincoln Financial Distributors, Inc., Radnor, PA. Securities
and investment advisory services offered through other affiliates. Explore Lincoln.


LFD0607-1577NY
LCN-2008249busrep