Qualified Annuity Claimant s Statement

Instructions – Important Information – please read carefully and completely

Annuity Death Claim Items that are always required:

d Certified death certificate showing the manner of death (non-returnable).

d Claimant’s Statement completed and signed by each beneficiary. Each beneficiary must have a separate

Claimant’s Statement.

Additional documentation and instructions may be required when the beneficiary is a(n):

d Estate d Trust

d Guardian (minors and incompetent beneficiaries) d Corporation

d Partnership

d Assignment to third parties

Please refer to the Distinctive Payee Arrangements form (number CL05984A) for full instructions.

Power of Attorney: If an attorney-in-fact under a Power of Attorney is completing the Annuity Claimant’s Statement on behalf of the claimant, a copy of the Power of Attorney document must be provided. If the Power of Attorney document was executed more than three years ago, additional information from the attorney-in-fact may be required. The Social Security number of the person who granted the Power of Attorney must be used. The attorney-in-fact’s Social Security number may not be used.

Other Possible Requirements (please note that failure to include this information where applicable may cause delay in processing the claim.):

d Deceased Beneficiary – if any named beneficiary of the contract is deceased, a copy of the death certificate of such

deceased beneficiary must accompany this form.

d Foreign Death – if death of the owner/annuitant/participant occurred outside of the United States, we will

require a Report of the Death of an American Citizen Abroad and a Foreign Death Questionnaire. A Translated Certified Copy of the Death Certificate may also be required.

d Consent to transfer or a state tax waiver – A form for consent or notice is required in some states. When

consent is required, the state must give approval before the death benefit can be paid. If this form is required, it will be provided to the beneficiary by us.

Variable Annuities: If the contract has money in variable sub-accounts, the money is subject to market fluctuations. You may be able to transfer money to different sub-accounts or to a Fixed account with written authorization signed by all beneficiaries and a copy of the death certificate.

The Lincoln National Life Insurance Company (Lincoln) does not require that the policy(ies) be returned to Lincoln for filing of a claim. However, Lincoln does ask that the relevant policy(ies) be destroyed once payment is received.

Contract Number: ___________________________

The Lincoln National Life Insurance Company

Service Office P.O. Box 7880 Fort Wayne, IN 46801-7880 Phone: 800-454-6265, Ext.*8200 www.LincolnFinancial.com

Overnight Address:

Lincoln Financial Group Death Claims - IA 1300 S Clinton St. Fort Wayne, IN 46802

Required Minimum Distribution

The Internal Revenue Service (IRS) requires that a distribution begin by April 1st _{of the year following the year in which the}

owner/annuitant/participant reaches age 70½_{. The distributions that the owner/annuitant/participant must receive are known as}

“Required Minimum Distributions”. The date by which the owner/annuitant/participant must start receiving payments is known as the “Required Beginning Date”. If the owner/annuitant/participant had reached the Required Beginning Date prior to death, a distribution is required for the year in which death occurred unless the required distribution had already been taken by the decedent. Please indicate whether or not the Required Minimum Distributions for the year of death has been taken.

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The Required Minimum Distribution for the year of death has been taken.

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Please withdraw the Required Minimum Distribution for the year of death.

The IRS requires that Required Minimum Distributions continue after the owner/annuitant/participant’s death at least as rapidly as they were being distributed prior to the death. Failure to receive distributions at least as rapidly as required can result in a 50% penalty on the amount not distributed. If you have any questions concerning Required Minimum Distributions, please consult your tax advisor.

Deceased’s Information

If the deceased was known by any other names, such as maiden name, hyphenated name, nickname, derivative form of the first and/or middle name, please include them below:

Name: _______________________________________________________________________________________________ Social Security Number: ___________________ Date of Birth: ___________________ Date of Death: ______________ Citizenship: Was deceased a U.S. Citizen?

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Yes

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No Country of Citizenship: _________________________________ Address: _____________________________________________________________________________________________ City: ____________________________________________________ State: _________ Zip: _______________________

Claimant Information

Relationship _____________________ Gender:

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Male

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Female Claimant’s relationship to Decedent: I am filing this claim as:

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An individual who is a named beneficiary under the policy. Social Security Number: ___________________________

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A Trustee of a Trust which is a named beneficiary under the policy. Trust TIN Number:__________________________

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An Executor of an Estate which is a named beneficiary under the policy. Estate TIN: ___________________________

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Other: _________________________________ Tax ID Number: _________________________________________ Name: ___________________________________________________________ Date of Birth: ________________________ Citizenship: Under penalties of perjury, I certify that:

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The number shown on this form is my correct taxpayer identification number, I am not subject to backup withholding and I am a US citizen or other US person

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I am not a US Citizen. Country of Citizenship: __________________________________

If you are a resident of a foreign country, a W-8BEN or a W-9 must be completed.

This form can be found at: http://www.irs.gov/pub/irs-pdf/fw9.pdf or http://www.irs.gov/pub/irs-pdf/fw8ben.pdf

Address: _____________________________________________________________________________________________ City: ____________________________________________________ State: _________ Zip: _______________________ Primary Telephone No: _____________________________________ Secondary Telephone No: ______________________

For your convenience and assistance when your claim is approved, pages 3 through 5 offer you the ability to receive your death benefits or place your funds into one of the other payment options. Please read your options carefully and know that Lincoln is available to address any questions that you may have. The options are numbered for your convenience.

Payment Options:

Please select one of the following options. Please Note: If the owner of the Contract/Certificate has previously designated a payment option, Lincoln is required to disburse funds pursuant to that designation.

Option 1

– (Option 1 is a Taxable Event.)

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LUMP SUM – Three options are provided

Method Of Distribution - Select ONE distribution method – A, B or C

METHOD A: CHECK (If no method of distribution is selected, will default to check.)

Select One:

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_{Regular Mail}(No Fee)

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Overnight Mail ($25 fee, subject to change)

Select One:

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Claimant’s Address

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Alternate Address (complete mailing information below)

Name: ___________________________________________________________________________________ Address: ___________________________________________________________________________________ City: __________________________________________ State:________ Zip: _______________________

METHOD B: DIRECT DEPOSIT (ACH, no fee) A check will be issued if all of the direct deposit requirements are not complete.

Cannot do direct deposit to a foreign or overseas account.

Select One:

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Checking - Must attach a copy of a “voided” check. Account must be in the same name as the beneficiary.

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Savings - Must attach the following information on the Financial Institution’s letterhead:

d Routing Number d Account Number d Accountholder’s Name

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Brokerage Account - Must attach the following information on the Financial Institution’s letterhead: d Routing Number

d Account Number d Accountholder’s Name

METHOD C: WIRE DEPOSIT (wire fees: $25 for domestic; $40 for foreign; all fees subject to change)

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Wire Deposit- Must attach the following information on the Financial Institution’s letterhead: d Routing Number

d Account Number d Accountholder’s Name

d Financial Institution’s Name and full Address d Further Credit to Account Number

Option 2

– (Only Available for Spousal Beneficiaries, not available for 403 (b) or 457 contracts) Please proceed to the election of beneficiary section on page 8 to change the beneficiary(ies) of this policy. If you do not name a beneficiary, the beneficiary will be your estate.

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ASSUME OWNERSHIP

As the surviving spouse and sole primary beneficiary of this annuity policy, I wish to be designated as the successor owner. I understand that the policy will remain in force with the original effective date with no change of policy provisions and no death benefit distribution will occur. I also understand this ownership change is not taxable.

Note that the term “spouse” as used in this Claimant’s Statement means a spouse as defined under Federal law, which only confers marriage rights and privileges and certain tax benefits to lawfully married couples. Current Federal law defines the term “spouse” to include an individual married to a person of the same or opposite gender if the individuals are lawfully married under state law. The term “spouse” does not include a domestic partner, civil union partner, or other status that is not recognized as a spouse under Federal law. Therefore, the payment option, Assume Ownership, is only available to a surviving spouse of a lawful marriage.

If the Dollar Cost Averaging program or the Automatic Withdrawal Service program was established under the original contract, it will be terminated. As surviving spouse, you may start a new program. If so, please select one of the following:

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Start a new Dollar Cost Averaging program (a separate election form is needed).

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Start a new Automatic Withdrawal Service program and complete page 6.

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Continue the existing i4Life that is currently on the contract only if a secondary life selection is present on the original election. (complete form CL07414)

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Start a new i4Life program (a separate election form is needed)

Option 3

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5 YEAR DEFERRAL - (This option is not available if the date of death of the Owner/Annuitant is on April 1st or later of the year following the year in which the owner reached age 70½.) Please review the automatic withdrawal service information section on page 6 and proceed to the election of beneficiary(ies) section on page 8 to change the beneficiary(ies) under this policy. If you do not name a beneficiary, the beneficiary will be your estate.

This option is available for death benefits of $10,000 or more.

As provided by Section 401(a)(9) of the Internal Revenue Code, the claimant must surrender and take full distribution of the

proceeds no later than December 31st _{following the fifth anniversary of the decedent’s date of death. A Five-Year Deferral postpones}

payment of the proceeds for up to five years from the original owner’s date of death. No additional money may be added to the contract. Distributions are taxable as they are made and will be reported as ordinary income on IRS Form 1099-R. If electing a Five-Year Deferral, it is not necessary to return the contract to us. You may name your beneficiary(ies) in the election of beneficiary

Option 4

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ANNUITIZATION OPTION – (Requires completion of Annuitization Form)

This option is available for death benefits of $5,000 or more. This option must begin within one year of the Death of the Owner/Annuitant. The selection of this option is irrevocable. Some of the options may not be available in some instances due to IRS regulations or possible restrictions of the plan in which you may have been participating. Please refer to the Prospectus or to your plan.

Life Options:

Life Only: Proceeds are paid in installments as long as you are living. Payments cease at your death.

Life with Period Certain: Proceeds are paid in installments as long as you are living. If you die within the time period you elected after payments start, we will continue payments to your beneficiary for the balance of the time period elected.

Life with Unit Refund (Variable payout only): Proceeds are paid in installments as long as you are living. If you die

prior to the return of all units, remaining units will be returned to your beneficiary as a lump sum.

Life with Cash Refund (Fixed payout only): Proceeds are paid in installments as long as you are living. If you die

prior to the return of your premium, remaining funds will be returned to your beneficiary as a lump sum.

Life with Installment Refund: Proceeds are paid in installments as long as you are living. If you die prior to the return of full premium, we will continue payments to your beneficiary until the premium has been satisfied.

Non-Life Options:

Installment for a Designated Period: Proceeds are paid in equal installment for any number of years you select. (Restrictions may apply)

Installment for a Designated Amount (100% Fixed payout only): Payments are made in equal installments of an

amount you select until the proceeds are exhausted.

Option 5

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DECEASED IRA/403(B) (For fixed annuities a new application is required.) (Please complete the

automatic withdrawal service information section on page 6 and proceed to the election of beneficiary(ies) section on page 8 to change the beneficiary(ies) under this policy. If you do not name a beneficiary, the beneficiary will be your estate.)

This option is available to spouse and non-spouse claimants for death benefits of $10,000 or more. With this option, distributions based on the claimant’s life expectancy must begin by December 31st _{of the year following}

the year of the owner/annuitant/participant’s death. (A spouse beneficiary can defer distributions until December 31st _{of the}

year the decedent would have reached age 70½). Distributions may be accelerated, but may not be decreased or stopped.

The death benefit payable to your beneficiary at your death is the account value, which may be subject to market fluctuation.

Option 6

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DIRECT ROLLOVER - (This option allows the transfer of funds to another Lincoln contract or another financial/ institution carrier.)

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Additional forms required for a direct rollover to another Lincoln contract: - Application for the new contract

- Request for Qualified Retirement Account Transfer/Direct Rollover - Disclosure Notice

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Additional forms required for a direct rollover to another financial institution/carrier: - Direct rollover form from other financial institution/carrier

- Acceptance letter from other financial institution/carrier

Automatic Withdrawal Service Information

(This service is not available for annuitization options.)

Please complete this section if payment option 5 was selected. This section is optional if payment options 2 or 4 were selected.

Automatic Withdrawal Options - Select ONE (‘Required Minimum Distribution’ (RMD) will be the default amount if amount not specified)

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Withdraw $ _________________ per payment frequency

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Required Minimum Distribution (RMD)/ Life Expectancy Payment rules Payment Information

Requested Start Date (month/year)_________________________ (Start Date of withdrawl defaults to 5th _{if Date option not selected, but} recurring withdrawl date defaults to 20th _{if option not selected.)}

Frequency:

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Monthly (If frequency is not selected, it will be monthly.)

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Quarterly

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Semi-Annually

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Annually Date of Withdrawal:

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5th

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10th

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20th (If date is not selected it will be the 20th_.)

Payment Deposit Information (If no payment option is completed, a check will be mailed to the client’s address of record.)

Select One:

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Checking - Must attach a copy of a “voided” check

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Savings - Must attach the following information on the Financial Institution’s letterhead: d Routing Number

d Account Number d Accountholder’s Name

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Brokerage Account - Must attach the following information on the Financial Institution’s letterhead: d Routing Number

d Account Number d Accountholder’s Name

Tax Withholding Section

Tax withholding election will remain in effect unless Lincoln is notified of a change. You may change your election at any time. If you opt out of tax withholding, you are still liable for applicable taxes on your distribution. You may also incur penalties under the estimated tax payment rules if your withholding and estimated tax payments are not sufficient. You may wish to discuss your withholding election with a qualified tax adviser.

If tax information is not provided, federal and applicable state taxes will be withheld.

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Select to withhold the minimal Federal tax and minimal State tax (if applicable).

Federal tax withholding:

(Note: It is mandatory that 20% federal income tax be withheld from a 403(b).)

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I elect to have no federal income tax withheld.

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I elect to have __________% federal income tax withheld. (Minimum of 10%)

State Tax Withholding Options

Option 1: All States Except CA and VT

If federal income tax is withheld, state income tax may be withheld depending on your state of residence.

AK, AZ, FL, HI, NV, NH, RI, SD, TN, TX, WA, WY: No state income tax.

DC, IA, ME, MA, NE, OK, VA: If federal income tax is withheld, mandatory state tax withholding is required.

AR, OR: If federal tax is withheld, you may opt out of state withholding.

DE, KS: If subject to mandatory federal tax withholding, then state income tax is also required. Otherwise, you may opt out of state income tax withholding.

MI: Must elect or opt out of state income tax withholding on form MI W-4P.

NC: Mandatory withholding will apply unless form NC-4P is submitted to opt out or withhold more than the minimum.

All Other States: Tax withholding is voluntary. State of residence: ___________________

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Voluntary tax amount: $___________________OR____________%

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OPT OUT (Do not withhold state income tax)

Option 2: CA and VT

CA: If federal tax is withheld, you may opt out of state withholding. If state tax withholding is elected, the minimum withholding must equal 10% or more of the federal withholding amount.

VT: If federal income tax is withheld, mandatory state tax withholding is required and must equal 24% or more of the federal withholding amount.

State of residence: ______

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______% this will be based on the taxable portion of the gross distribution

Election of Beneficiary Section

(If Claimant does not elect a Beneficiary payment will default to the Claimant’s estate.)

Primary(you must have at least one primary beneficiary)Please use whole percentages. Itemized percentages must equal 100%

Name: __________________________________ Relationship:______________ Percentage: ______________________ Social Security/Tax ID Number: _______________ Date of Birth: _____________ Gender:

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Male

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Female

Address: _____________________________________________________________________________________________

City: ____________________________________________________ State: ________ ZIP: ______________________

Telephone Number: _____________________________________________________________________________________

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Primary

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Contingent

Name: __________________________________ Relationship:______________ Percentage: ______________________ Social Security/Tax ID Number: _______________ Date of Birth: _____________ Gender:

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Male

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Female

Address: _____________________________________________________________________________________________

City: ____________________________________________________ State: ________ ZIP: ______________________

Telephone Number: _____________________________________________________________________________________

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Primary

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Contingent

Name: __________________________________ Relationship:______________ Percentage: ______________________ Social Security/Tax ID Number: _______________ Date of Birth: _____________ Gender:

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Male

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Female

Address: _____________________________________________________________________________________________

City: ____________________________________________________ State: ________ ZIP: ______________________

Telephone Number: _____________________________________________________________________________________

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Primary

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Contingent

Name: __________________________________ Relationship:______________ Percentage: ______________________ Social Security/Tax ID Number: _______________ Date of Birth: _____________ Gender:

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Male

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Female

Address: _____________________________________________________________________________________________

City: ____________________________________________________ State: ________ ZIP: ______________________

Telephone Number: _____________________________________________________________________________________

If designating a trust as beneficiary, complete the following:

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Primary

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Contingent

Name: ____________________________________________________________ Percentage: ______________________ Trustee’s Name: ____________________________________________________ Date of Trust: _____________________ Telephone Number: ___________________________ Social Security/ Tax ID Number: ______________________________ Address: ___________________________________________________________________________________

City: ____________________________________________________ State: ________ ZIP: ____________

If additional beneficiaries are to be named, please check here

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and attach on a separate sheet which must be signed and dated by you. You may also make additional copies of this page if necessary.

Telephone/Internet Authorization

(check box if this option is not desired.)

For your convenience, the Company will accept certain account changes via telephone or the internet. You may opt out by checking the box below. This telephone/internet authorization remains in effect until written cancellation signed by the Contract Owner(s) is received by the Company’s Servicing Office.

I/We hereby authorize and direct the Company to accept instructions via telephone or the internet from any person including my/ our registered representative who can furnish proper identification to exchange units from sub account to sub account, change the allocation of future investments, and/or clarify any unclear or missing administrative information contained on the application at the time of issue. I/We agree to hold harmless and indemnify the Company and its affiliates and any mutual fund managed by such affiliates and their directors, trustees, officers, employees and agents for any losses arising from such instructions.

If you DO NOT want Telephone/Internet Authorization check this box

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Signature

The Internal Revenue Service does not require your consent to any provision of this document other than the certification required to avoid backup withholding.

You understand that by furnishing a claim form, the Company does not acknowledge that there is a contract in force or that you are the designated beneficiary. If necessary, the Company may ask for more information to confirm this claim.

By signing below, you certify that you:

Authorize the direct deposit of the payment into the account identified on this form. This authorization requires the financial institution to be a member of the National Automated Clearing House Association (NACHA). Lincoln is also authorized to initiate corrections, if

necessary, to any amounts credited or debited to your account in error. You also agree to hold Lincoln harmless for the date funds are actually credited to your account by your financial institution. This authorization will remain in effect until your funds are depleted or you notify Lincoln of change in sufficient time to act.

Understand and assume full responsibility for meeting the Internal Revenue Code requirements to qualify for this distribution. You further agree to hold Lincoln harmless for any adverse tax ramifications that may arise based on the information provided on this form.

Fraud Warning for New York Residents:

Any person who knowingly and with intent to defraud any insurance company or other person files an application for insurance or statement of claim containing any materially false information, or conceals for the purpose of misleading, information concerning any fact material thereto, commits a fraudulent insurance act, which is a crime, and shall also be subject to a civil penalty not to exceed five thousand dollars and the stated value of the claim for each such violation.

This form is not complete until it is signed by the Claimant

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Claimant’s Full Legal Name (Please Type or Print) Always required to be completed

____________________________________________________________ __________________________________

Claimant’s Signature Date

____________________________________________________________ ________________________

Warning

– Any person who knowingly and with intent to injure, defraud or deceive any insurance company

or other person files a statement of claim containing any false, incomplete or misleading information or

conceals, for the purpose of misleading, information concerning any fact material to the claim, commits

a fraudulent insurance act, which may be a crime, and in certain states a felony. Penalties may include

imprisonment, fines, denial of insurance and civil damages.

These states require the following fraud warnings:

California

(For your protection, California law requires this to appear.) – Any person who knowingly presents

false or fraudulent claim for the payment of a loss is guilty of a crime and may be subject to fines and

confinement in state prison.

Colorado

– It is unlawful to knowingly provide false, incomplete, or misleading facts or information to an

insurance company for the purpose of defrauding or attempting to defraud the company. Penalties may include

imprisonment, fines, denial of insurance, and civil damages. Any insurance company or agent of an insurance

company who knowingly provides false, incomplete, or misleading facts or information to a policyholder or

claimant for the purpose of defrauding or attempting to defraud the policyholder or claimant with regard to a

settlement or award payable from insurance proceeds shall be reported to the Colorado division of insurance

within the department of regulatory agencies.

District of Columbia: WARNING:

It is a crime to provide false or misleading information to an insurer for

the purpose of defrauding the insurer or any other person. Penalties include imprisonment and/or fines.

In addition, an insurer may deny insurance benefits, if false information materially related to a claim was

provided by the applicant.

Kentucky

– Any person who knowingly and with intent to defraud any insurance company or other person files

a statement of claim containing any materially false information or conceals, for the purpose of misleading,

information concerning any fact material thereto commits a fraudulent insurance act, which is a crime.

Minnesota

– A person who files a claim with intent to defraud or helps commit a fraud against an insurer is

guilty of a crime.

New Hampshire

– Any person who, with a purpose to injure, defrauds or deceives any insurance company,

files a statement of claim containing any false, incomplete or misleading information is subject to prosecution

and punishment for insurance fraud, as provided in

N.H. Rev. Stat. Ann. Subsection 638:20.

New Jersey

– Any person who knowingly files a statement of claim containing false or misleading information

is subject to criminal and civil penalties.

Pennsylvania

– Any person who knowingly and with intent to defraud any insurance company or other person

files an application for insurance or statement of claim containing any materially false information or conceals

for the purpose of misleading, information concerning any fact material thereto commits a fraudulent insurance

act, which is a crime and subjects such person to criminal and civil penalties.

Puerto Rico

– Any person who knowingly and with the intention of defrauding presents false information

in an insurance application, or presents, helps, or causes the presentation of a fraudulent claim for the

payment of a loss or any other benefit, or presents more than one claim for the same damage or loss, shall

incur a felony and, upon conviction, shall be sanctioned for each violation with the penalty of a fine of not

less than five thousand ($5,000) dollars and not more than ten thousand ($10,000) dollars, or a fixed term

of imprisonment for three (3) years, or both penalties. Should aggravating circumstances are present, the

penalty thus established may be increased to a maximum of five (5) years, if extenuating circumstances are

present, it may be reduced to a minimum of two (2) years.

The Lincoln Financial Group companies* are committed to protecting your privacy. To provide the products and services you expect from a financial services leader, we must collect personal information about you. We do not sell your personal information to third parties. This Notice describes our current privacy practices. While your relationship with us continues, we will update and send our Privacy Practices Notice as required by law. Even after that relationship ends, we will continue to protect your personal information. You do not need to take any action because of this Notice, but you do have certain rights as described below.

Information We May Collect And Use

We collect personal information about you to help us identify you as our customer or our former customer; to process your requests and transactions; to offer investment or insurance services to you; to pay your claim; or to tell you about our products or services we believe you may want and use; and as otherwise permitted by law. The type of personal information we collect depends on the products or services you request and may include the following:

• _{Information from you: When you submit your application or other forms, you give us information such as your} name, address, Social Security number; and your financial, health, and employment history.

• _{Information about your transactions: We maintain information about your transactions with us, such as the} products you buy from us; the amount you paid for those products; your account balances; and your payment and claims history.

• _{Information from outside our family of companies: If you are purchasing insurance products, we may} collect information from consumer reporting agencies such as your credit history; credit scores; and driving and employment records. With your authorization, we may also collect information, such as medical information from other individuals or businesses.

• _{Information from your employer: If your employer purchases group products from us, we may obtain information} about you from your employer in order to enroll you in the plan.

How We Use Your Personal Information

We may share your personal information within our companies and with certain service providers. They use this information to process transactions you have requested; provide customer service; and inform you of products or services we offer that you may find useful. Our service providers may or may not be affiliated with us. They include financial service providers (for example, third party administrators; broker-dealers; insurance agents and brokers, registered representatives; reinsurers and other financial services companies with whom we have joint marketing agreements). Our service providers also include non-financial companies and individuals (for example, consultants; vendors; and companies that perform marketing services on our behalf). Information we obtain from a report prepared by a service provider may be kept by the service provider and shared with other persons; however, we require our service providers to protect your personal information and to use or disclose it only for the work they are performing for us, or as permitted by law.

When you apply for one of our products, we may share information about your application with credit bureaus. We also may provide information to group policy owners, regulatory authorities and law enforcement officials, and to other non-affiliated or affiliated parties as permitted by law. In the event of a sale of all or part of our businesses, we may share customer information as part of the sale. We do not sell or share your information with outside marketers who may want to offer you their own products and services; nor do we share information we receive about you from a consumer reporting agency. You do

We have an important responsibility to keep your information safe. We use safeguards to protect your information from unauthorized disclosure. Our employees are authorized to access your information only when they need it to provide you with products, services, or to maintain your accounts. Employees who have access to your personal information are required to keep it confidential. Employees are trained on the importance of data privacy.

Your Rights Regarding Your Personal Information

Access: We want to make sure we have accurate information about you. Upon written request we will tell you, within 30 business days, what personal information we have about you. You may see a copy of your personal information in person or receive a copy by mail, whichever you prefer. We will share with you who provided the information. In some cases we may provide your medical information to your personal physician. We will not provide you with information we have collected in connection with, or in anticipation of, a claim or legal proceeding. If you request a copy of the information, we may charge you a fee for copying and mailing costs. In very limited circumstances, your request may be denied. You may then request that the denial be reviewed. Accuracy of Information: If you feel the personal information we have about you is inaccurate or incomplete, you may ask us to amend the information. Your request must be in writing and must include the reason you are requesting the change. We will respond within 30 business days. If we make changes to your records as a result of your request, we will notify you in writing and we will send the updated information, at your request, to any person who may have received the information within the prior two years. We will also send the updated information to any insurance support organization that gave us the information, and any service provider that received the information within the prior 7 years. If your requested change is denied, we will provide you with reasons for the denial. You may write to request the denial be reviewed. A copy of your request will be kept on file with your personal information so anyone reviewing your information in the future will be aware of your request.

Accounting of Disclosures: You may request an accounting of disclosures made of your medical information, except for disclosures:

• For purposes of payment activities or company operations;

• To the individual who is the subject of the personal information or to that individual’s personal representative;

• To persons involved in your health care;

• For notification for disaster relief purposes;

• For national security or intelligence purposes;

• To law enforcement officials or correctional institutions; or

• For which an authorization is required.

You may request an accounting of disclosures for a time period of less than two years from the date of your request.

You may ask in writing for the specific reasons for an adverse underwriting decision. An adverse underwriting decision is where we decline your application for insurance, offer to insure you at a higher than standard rate, or terminate your coverage.

Your state may provide for additional privacy protections under applicable laws. We will protect your information in accordance with these additional protections.

Questions about your personal information should be directed to:

Lincoln Financial Group

Attn: Enterprise Compliance and Ethics Corporate Privacy Office, 7C-01

1300 S. Clinton St. Fort Wayne, IN 46802

Please include all policy/contract/account numbers with your correspondence. *This information applies to the following Lincoln Financial Group companies:

First Penn-Pacific Life Insurance Company Lincoln Life & Annuity Company of New York

Lincoln Financial Group Trust Company, Inc. Lincoln Retirement Services Company, LLC

Lincoln Financial Investment Services Corporation Lincoln Variable Insurance Products Trust