APPLICATION FOR ANNUITY 850 East Anderson Lane • Austin ... · 6/24/2015 · APPLICATION FOR ANNUITY 850 East Anderson Lane • Austin, Texas 78752-1602 01-9046-14 ANNUITANT:

APPLICATION FOR ANNUITY850 East Anderson Lane • Austin, Texas 78752-1602

01-9046-14

ANNUITANT:

OWNER:

Name _______________________________________Sex ___ DOB _________ Age____ Email Address ________________________Address ____________________________________________City ________________________ State ___________ Zip __________Drivers License No. and State ___________________________ SSN ______________________ Telephone No. ________________

BENEFICIARY:Primary Beneficiary ____________________________________________ SSN/TIN______________________DOB______________Address _____________________________________________________________Email Address ____________________________Telephone No. __________________________________ Drivers License No. and State ____________________________________Relationship to Annuitant ______________________________________________ Percent of Benefit __________________________Primary Beneficiary ____________________________________________ SSN/TIN______________________DOB______________Address _____________________________________________________________Email Address ____________________________Telephone No. __________________________________ Drivers License No. and State ____________________________________Relationship to Annuitant ______________________________________________ Percent of Benefit __________________________PLAN:

PREMIUMS:

Tax Status: ❒ IRA ❒ SEP-IRA ❒ ROTH-IRA ❒ Non-Qualified ❒ Other* (Must also mark one box below)

❒ 401(K) ❒ Profit Sharing ❒ Defined Benefit ❒ Keogh/HR10 ❒ Money Purchase Plan*Satisfaction of applicable tax qualifications and all other legal requirements regarding the tax qualified status of the plan is the responsi-bility of the plan sponsor and/or administrator, not National Western. National Western will issue a non-qualified annuity under this option.

Submitted with application $____________________________ If IRA, premium submitted applies to tax year____________________Amount to be billed $ _________________________________ Expected first year premium $ ________________________________Anticipated amount on policy exchanges or transfers $ ________________________________________________________________(If any, attach Transfer Form No. SA-8600, the policy/document that is to be exchanged.)Mode: ❒ Single Premium ❒ Annual ❒ Semi-annual ❒ Monthly ❒ Other ___________________________________Billing Type: ❒ Bank Draft ❒ Direct Bill ❒ List Bill ❒ Government Allotment ❒ Other ___________________________________Special Billing Instructions: Billing Name ____________________________________________________________________________Address __________________________________________________City _____________________State _________Zip __________

Full Name (if other than annuitant) __________________________________________________________________________________Sex ______ DOB____________ Age ______ Email Address ________________________________Address ____________________________________________City ________________________ State ___________ Zip __________Drivers License No. and State ___________________________ SSN/TIN____________________ Telephone No. ________________Joint Owner ___________________________________________________________________________________________________Sex ______ DOB____________ Age ______ Email Address ________________________________Address ____________________________________________City ________________________ State ___________ Zip __________Drivers License No. and State ___________________________ SSN/TIN____________________ Telephone No. ________________Contingent Owner (if other than annuitant)____________________________________________________________________________Sex ______ DOB____________ Age ______ Email Address ________________________________Address ____________________________________________City ________________________ State ___________ Zip __________Drivers License No. and State ___________________________ SSN/TIN____________________ Telephone No. ________________

This section must be left blank on IRA and SEP plans.

Plan Name _____________________________________________________________________________________________

CO-ANNUITANT: Name _______________________________________Sex____ DOB _________ Age____ Email Address ________________________Address ____________________________________________City ________________________ State ___________ Zip __________Drivers License No. and State ___________________________ SSN ______________________ Telephone No. ________________

OTHER COVERAGE AND REPLACEMENT:1. Does the applicant have any existing life insurance or annuity contracts? .................................................................. ❒ Yes ❒ No2. If yes, is this annuity intended to replace or change any existing life insurance or annuity contracts? ............................ ❒ Yes ❒ No(If yes, please submit appropriate state replacement forms.)

Page 1 of 2

Attach additional beneficiary or contingent beneficiary information on separate page. Percent must add up to 100%.

AGENT’S SECTION:1. Does the applicant have any existing life insurance or annuity contracts? .................................................................. ❒ Yes ❒ No2. If yes, is this annuity intended to replace any existing life insurance or annuity contracts? .............................................. ❒ Yes ❒ No(If yes, please submit appropriate state replacement forms.)USA PATRIOT Act Notice1. The USA PATRIOT Act requires that we establish an Anti-Money Laundering (AML) Compliance Program, and as part of our Program,

National Western Life Insurance Company® requires that its agents/brokers/consultants verify the identity of the proposed owner(s) ofour contracts and collect documents and/or information sufficient to provide such verification. Please refer to your company-specificAML training materials for more detailed information.Owner/Trustee Verification - In order to satisfy such obligations, we require that you review and verify a current driver’s license or government-issued photo ID for the proposed Owner/Trustee associated with the contract.

2. Do you certify that you personally met with the proposed Owner/Trustee and reviewed his or her identification document (driver’s license or government-issued photo ID) and that to the best of your knowledge, it accurately reflects the identity of the proposed Owner/Trustee?........................................................................................................ ❒ Yes ❒ NoIf no, please explain __________________________________________________________________________________________________________________________________________________________________________

Agent Signature _______________________________________________________ Agent Number ____________________________

Agent Name (printed) ___________________________________________________ Agent Phone ____________________________

Commission Splits: Agent Number Agent Name Commission Split________________________________ __________________________________ ____________________________________________________________________ __________________________________ ____________________________________________________________________ __________________________________ ____________________________________________________________________ __________________________________ ____________________________________

***ALL CHECKS MUST BE PAYABLE TO NATIONAL WESTERN LIFE INSURANCE COMPANY®***

✗

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Print Annuitant’s Name __________________________________________________ Date ____________________________ Page 2 of 2

NATIONAL WESTERN LIFE INSURANCE COMPANY®

850 EAST ANDERSON LANE • AUSTIN, TEXAS 78752-1602

I have read the statements above and to the best of my knowledge and belief they are true and complete. Any statement made by eitherthe agent of this application or by any other person shall not be binding on the Company unless such statement is reduced to writing bythe Company and made a part of the annuity contract. I have received and read a copy of the annuity information brochure and under-stand the features of the plan of insurance applied for. I am not currently taking, and I am not under the influence of, any medications ordrugs that would affect my ability to fully understand and accurately complete this application.

ANY PERSON WHO KNOWINGLY PRESENTS A FALSE STATEMENT IN AN APPLICATION FOR INSURANCE MAY BE GUILTY OFA CRIMINAL OFFENSE AND SUBJECT TO PENALTIES UNDER STATE LAW.Signed in (City) ______________________________________________ (State) ____________ on (date) ______________________

01-9046-14

SPECIAL REQUESTS:

✔ Owner Signature Joint Owner Signature (Include title if signing on behalf of a minor,Trust, Corp, or any other entity)

Agent Signature

✔

Annuitant Co-Annuitant ✔ ✔

✔

01-S026(Rev.01/10)

Annuity Withdrawal Benefit Rider Application Supplement

To apply for Withdrawal Benefit Rider form 01-3128-08, or 01-3128-09, and state variations Complete this application supplement to add the Withdrawal Benefit Rider to your annuity. This application supplement MUST BE completed and returned with the annuity application. The Withdrawal Benefit Rider WILL NOT be added to your annuity after the annuity application has been processed. There is a charge for this rider, which is assessed annually. The charge is deducted annually from the Account Value until the rider is terminated. The rider charge for rider form 01-3128-08 is based upon a percentage of the Account Value of the annuity. The rider charge for rider form 01-3128-09 is based upon a percentage of either: 1. The Accumulation Period Withdrawal Payment Base during the Accumulation Period, or 2. the Withdrawal Payment Base during the Withdrawal Period. Annuitant: _______________________________________________ Date of Birth _____________________ (Must be the same as the annuity application) Joint Annuitant, if any: ______________________________________ Date of Birth _____________________ Owner:___________________________________________________ Date of Birth _____________________ (Must be the same as the annuity application) Joint Owner: ______________________________________________ Date of Birth _____________________ (Must be the same as the annuity application) Dated at (city and state) _______________________ this __________ day of ___________________ 20 ____ . Owner Signature _________________________________ Annuitant Signature ________________________ Joint Owner Signature _____________________________ Agent Signature as Witness ______________________________________________ Date ________________ Agent Name _____________________________________________Agent Number _____________________

DM-1049.Rev.10.11

National Western Life Insurance Company®

850 East Anderson LaneAustin, Texas 78752

INCOME OUTLOOK

NWL®’s Withdrawal Benefit Rider01-3128-08

A Sure WIN to Provide Security For Your Withdrawal Income Needs!

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NWL®’s Income Outlook provides:

• Great growth potential for your lifetime Withdrawal Payments...

• Control of when your Withdrawal Payments begin...

• Guaranteed Withdrawal Percentages that increase every year...

• Access to your money for Additional Withdrawals remains...

• Guaranteed Withdrawal Payments for life anytime after the age of 60!

Adding Income Outlook to your National Western Life equity indexed annuity at purchase will give you all of these benefits. This withdrawal benefit rider works with all of your annuity’s traditional benefits and enhances the benefits with guaranteed Withdrawal Payments you cannot outlive.

INCOME OUTLOOK HIGHLIGHTSIncome Outlook guarantees during the Accumulation Period:

• 4% interest on the Accumulation Period Withdrawal Payment Base until lifetime WithdrawalPayments begin

• The Guaranteed Withdrawal Percentages increase every year until age 90 or until the lifetimeWithdrawal Payments begin

• Access to the annuity’s Account Value remains• The option to Restart the ten year Accumulation Period at the end of the fifth Policy Year

Income Outlook guarantees during the Withdrawal Period:• Withdrawal Payments that can be paid for life• The ability to stop and start Withdrawal Payments• No withdrawal charges on Withdrawal Payments taken under this rider• The Withdrawal Payment Base to Step-Up to the annuity’s Account Value*, if larger, when the

Withdrawal Period begins and each Policy Anniversary thereafter• The Maximum Guaranteed Annual Withdrawal Payment increases each time there is a Step-Up in the

Withdrawal Payment Base• Access to the annuity’s Account Value remains• Required Minimum Distribution friendly

*If the base annuity policy has a premium bonus that is not included in the Account Value, then for purposes of Restart, Step-Up, and

Withdrawal Payment Base, the Account Value will be increased by any applicable base annuity Vested Bonus Value.

INCOME OUTLOOK

NWL®’s Withdrawal Benefit Rider Enjoy the benefits of guaranteed lifetime retirement income with enhanced accumulations and control of your annuity!

National Western Life requires that the Agent review this entire brochure with you.


Income Outlook - Withdrawal Benefit RiderThank you for choosing to add Income Outlook to your National Western Life equity indexed annuity. If you have any questions, please contact your agent or call National Western’s Customer Service Department at 1-800-922-9422.

We want to be sure that you read all 12 pages of this brochure and are aware of the benefits and features explained herein. Please initial and sign where indicated with an asterisk (*), acknowledging that you understand the following:

• This is a withdrawal benefit rider that guarantees lifetime Withdrawal Payments after age 60.• For purposes of this brochure, the assumption is that the Annuitant and Owner are the same.• If you annuitize your annuity, this rider will terminate.• Once the Withdrawal Payments begin, there is no further Accumulation Period available.• The benefits of this rider are not obtained if the Withdrawal Payments are never taken. The Account Value of the policy is reduced each year for the Annual Rider Charge when Interest Credits are positive, regardless of whether Withdrawal Payments are taken.• If at the end of Accumulation Period you have not yet requested Withdrawal Payments or elected the Restart option, the Annual Rider Charge will continue to be deducted from the Account Value and the Accumulation Period Withdrawal Payment Base will no longer accumulate with interest.• Any election to start or stop withdrawal payments must be received at National Western Life Insurance Company at least 20 days prior to the Policy Anniversary.

______* The above-stated features have been fully explained to me.

I have received a copy of this brochure, and I have reviewed it with my agent. I fully understand the brochure and the specific points outlined above. The brochure is not a part of the rider and does not modify it in any way. The rider itself contains all terms, benefits, guarantees, limitations, restrictions, and exclusions.

__________________________________________*Applicant’s Signature Date

I certify that I reviewed this brochure with the applicant

__________________________________________Agent’s Signature & Agent No. Date

Applicant to RetainDM-1049-SIG.Rev.10.11 DM-1049-SIG.Rev.10.11










Submit with Application

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INCOME OUTLOOK DETAILSIncome Outlook is available to add as a rider to your National Western Life equity indexed annuity only at the time of purchase.

The Withdrawal Payment is the amount you choose to receive each year. The Maximum Guaranteed Annual Withdrawal Payment is guaranteed to be paid for your lifetime if no Additional Withdrawals are taken. Your age must be at least 60 before Withdrawal Payments may begin. You may begin taking Withdrawal Payments as early as the first Policy Anniversary or any Policy Anniversary you choose after that. The Withdrawal Payments taken under this rider are deducted from the annuity’s Account Value and will not incur any withdrawal charges.

There is an Annual Rider Charge for this benefit on each Policy Anniversary, beginning with the first. The Annual Rider Charge Rate is determined on the Policy Date and is shown on page 1 of the rider. This rate is guaranteed not to change while this rider is in force unless Restart (as described below) is elected and will never exceed the maximum rate of 1.00%. The Annual Rider Charge will never exceed, the smaller of:

1) the Annual Rider Charge Rate times the AccountValue on the Policy Anniversary, prior to any interestcredits; or

2) the Interest Credits on the Account Value for thePolicy Year.

In other words, the Annual Rider Charge will not reduce the annuity’s Account Value by more than the interest credits for that Policy Year.

The rider has two periods, the Accumulation Period and the Withdrawal Period. Each period is described as follows.

CancellationYou may cancel this rider at anytime. The rider will terminate when the annuity terminates for any reason or when the Maximum Guaranteed Annual Withdrawal Payment is less than $100.

CONCLUSIONIncome Outlook from National Western Life provides the security of a guaranteed income stream you can not outlive in retirement. This rider also offers the opportunity for larger income benefits when indexed interest credits increase your annuity’s Account Value. It also gives you control of your annuity as your needs change and access to your money if needed.

About the CompanyNational Western Life Insurance Company® is a Colorado corporation with executive offices in Austin, Texas. The Company offers a full line of life insurance and annuity products (both on an individual and group basis), through independent agency offices in 49 states and the District of Columbia, and accepts applications from residents of several foreign countries. Visit our website www.nationalwesternlife.com for all current financial information.

Since its start in 1956, National Western has emphasized financial strength for the protection of its policyholders. As a legal reserve insurance company, National Western must set aside a portion of its assets equal to reserves required by law. Annually, a financial statement is filed with each state’s insurance department. These departments have authority to verify that the appropriate reserves are maintained.

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During the Accumulation PeriodThe Accumulation Period Withdrawal Payment Base has a 4% interest rate that is guaranteed each year during the Accumulation Period. The Accumulation Period Withdrawal Payment Base initially equals the premium paid, plus any applicable premium bonus. Additional premiums paid and premium bonuses, if applicable, will be added to the Accumulation Period Withdrawal Payment Base when they are received. Withdrawals made from the Account Value will reduce the Accumulation Period Withdrawal Payment Base.

As the Payment Base grows, so do your guaranteed Withdrawal Payments for life.

RestartDuring the Accumulation Period, you may Restart the 4% guaranteed interest rate anytime after the fifth Policy Year. At the time you Restart the Accumulation Period, the following will happen:

• The 4% guaranteed interest rate on the Accumulation Period Withdrawal Payment Base will beguaranteed from Restart;

• The Accumulation Period Withdrawal Payment Base will be increased to the annuity’s Account Value*, if larger; and

• The Annual Rider Charge Rate may change, but will not be higher than the maximum guaranteed charge of 1%.

You must wait five years after each Restart before beginning a new Accumulation Period.

*If the base annuity policy has a premium bonus that is not included in the Account Value, then for purposes of Restart, Step-Up, and Withdrawal

Payment Base, the Account Value will be increased by any applicable base annuity Vested Bonus Value.

WithdrawalsWithdrawals may be made at anytime as provided by the annuity. Withdrawals from your annuity will reduce the Accumulation Period Withdrawal Payment Base by the same percentage reduction made to the annuity’s Account Value.

Issue Age

Number of Full Years of Accumulation before Withdrawal Payments Begin

1 2 3 4 5 6 7 8 9 10

60 $5,304 $5,624 $5,962 $6,317 $6,692 $7,086 $7,501 $7,938 $8,398 $8,881 61 $5,408 $5,732 $6,074 $6,434 $6,813 $7,212 $7,632 $8,075 $8,540 $9,029 62 $5,512 $5,841 $6,187 $6,551 $6,935 $7,339 $7,764 $8,211 $8,682 $9,178 63 $5,616 $5,949 $6,299 $6,668 $7,057 $7,465 $7,896 $8,348 $8,825 $9,326 64 $5,720 $6,057 $6,412 $6,785 $7,178 $7,592 $8,027 $8,485 $8,967 $9,474 65 $5,824 $6,165 $6,524 $6,902 $7,300 $7,718 $8,159 $8,622 $9,109 $9,622 66 $5,928 $6,273 $6,637 $7,019 $7,422 $7,845 $8,290 $8,759 $9,252 $9,770 67 $6,032 $6,381 $6,749 $7,136 $7,543 $7,972 $8,422 $8,896 $9,394 $9,918 68 $6,136 $6,490 $6,862 $7,253 $7,665 $8,098 $8,554 $9,033 $9,536 $10,066 69 $6,240 $6,598 $6,974 $7,370 $7,787 $8,225 $8,685 $9,169 $9,679 $10,214 70 $6,344 $6,706 $7,087 $7,487 $7,908 $8,351 $8,817 $9,306 $9,821 $10,362 71 $6,448 $6,814 $7,199 $7,604 $8,030 $8,478 $8,948 $9,443 $9,963 $10,510 72 $6,552 $6,922 $7,312 $7,721 $8,152 $8,604 $9,080 $9,580 $10,106 $10,658 73 $6,656 $7,030 $7,424 $7,838 $8,273 $8,731 $9,212 $9,717 $10,248 $10,806 74 $6,760 $7,139 $7,537 $7,955 $8,395 $8,857 $9,343 $9,854 $10,390 $10,954 75 $6,864 $7,247 $7,649 $8,072 $8,517 $8,984 $9,475 $9,991 $10,533 $11,102 76 $6,968 $7,355 $7,762 $8,189 $8,638 $9,110 $9,606 $10,127 $10,675 $11,250 77 $7,072 $7,463 $7,874 $8,306 $8,760 $9,237 $9,738 $10,264 $10,817 $11,398 78 $7,176 $7,571 $7,987 $8,423 $8,882 $9,363 $9,869 $10,401 $10,960 $11,546 79 $7,280 $7,679 $8,099 $8,540 $9,003 $9,490 $10,001 $10,538 $11,102 $11,694 80 $7,384 $7,788 $8,212 $8,657 $9,125 $9,616 $10,133 $10,675 $11,244 $11,842 81 $7,488 $7,896 $8,324 $8,774 $9,247 $9,743 $10,264 $10,812 $11,386 $11,842 82 $7,592 $8,004 $8,436 $8,891 $9,368 $9,869 $10,396 $10,949 $11,386 $11,842 83 $7,696 $8,112 $8,549 $9,008 $9,490 $9,996 $10,527 $10,949 $11,386 $11,842 84 $7,800 $8,220 $8,661 $9,125 $9,612 $10,123 $10,527 $10,949 $11,386 $11,842 85 $7,904 $8,328 $8,774 $9,242 $9,733 $10,123 $10,527 $10,949 $11,386 $11,842

$100,000 Premium – Maximum Guaranteed Annual Withdrawal Payments

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Example: A $20,000 withdrawal is made. The Account Value is $250,000 before the withdrawal. After the withdrawal the Account Value is $230,000, or 92% of the Account Value before the withdrawal. The Accumulation Period Withdrawal Payment Base is $240,000 before the withdrawal. It is multiplied by 92% and equals $220,800 after the Withdrawal.

The Accumulation Period ends when you begin taking Withdrawal Payments. At that time, the Withdrawal Period begins.

During the Withdrawal PeriodThe Withdrawal Payment amount you choose to receive is guaranteed to be paid for your lifetime if it does not exceed the Maximum Guaranteed Annual Withdrawal Payment. The Maximum Guaranteed Annual Withdrawal Payment will remain level unless there is a Step-Up in the Withdrawal Payment Base, or you take an Additional Withdrawal.

You may receive your Withdrawal Payment annually, semi-annually, quarterly, or monthly. Each payment must be at least $100. Any election to start or stop withdrawal payments must be received at National Western Life Insurance Company® at least 20 days prior to the Policy Anniversary.

When the Withdrawal Period begins:• The Guaranteed Withdrawal Percentage is determined;• The Withdrawal Payment Base is increased to the annuity’s Account Value* if it is larger;• The Maximum Guaranteed Annual Withdrawal Payment is calculated;• Any outstanding loan must be repaid; • No more loans or Systematic Withdrawals of Interest from the Account Value of the policy may be taken;

and• Any applicable penalty-free withdrawal amount that is available each Policy Year under the base annuity

policy will be reduced by the Withdrawal Payment.



The Guaranteed Withdrawal Percentage is based on your age at the beginning of the Withdrawal Period. This percentage will not change during the Withdrawal Period.

The Maximum Guaranteed Annual Withdrawal Payment equals the Withdrawal Payment Base multiplied by the Guaranteed Withdrawal Percentage.

Example: Five years ago, you purchased an annuity with Income Outlook with $100,000 and have now decided to begin Withdrawal Payments. The Withdrawal Payment Base is now $121,665 after five years of 4% interest and your Guaranteed Withdrawal Percentage is 6.8%. At this time, your Maximum Guaranteed Annual Withdrawal Payment is $8,273 and your annuity’s Account Value is $131,317. Therefore, the Withdrawal Payment Base is increased to the Account Value and your Maximum Guaranteed Annual Withdrawal Payment is $8,930.

$250,000- 20,000

$230,000

230,000 ÷ 250,000 = 92% $240,000x .92

$220,800

Accumulation Period WithdrawalPayment Base

Account Value

ADDITIONAL DETAILSIssue AgesIncome Outlook may be added to the annuity at purchase, regardless of age.

Premium AllocationPremiums may be allocated to any Interest Credit Options and in any combination that is allowed by the annuity. All premiums paid during the Accumulation Period are guaranteed to be included in the Accumulation Period Withdrawal Payment Base and will receive the 4% guaranteed interest rate.

AnnuitantsThe annuitant and joint annuitant, if any, cannot be changed after the annuity is issued.

Two annuitants are allowed on this rider only. The Withdrawal Payment is guaranteed to be paid until the death of the last surviving annuitant. The Guaranteed Withdrawal Percentage is based on the age of the younger annuitant.

Guaranteed Withdrawal PercentagesThe Guaranteed Withdrawal Percentage is based on your age on the Policy Anniversary that you begin Withdrawal Payments.

The table below has the Guaranteed Withdrawal Percentages when there are joint annuitants. The percentage is based on the age of the younger annuitant on the Policy Anniversary that you begin Withdrawal Payments.

Age Percentage Age Percentage Age Percentage Age Percentage60 5.00% 68 5.80% 76 6.60% 84 7.40%61 5.10% 69 5.90% 77 6.70% 85 7.50%62 5.20% 70 6.00% 78 6.80% 86 7.60%63 5.30% 71 6.10% 79 6.90% 87 7.70%64 5.40% 72 6.20% 80 7.00% 88 7.80%65 5.50% 73 6.30% 81 7.10% 89 7.90%66 5.60% 74 6.40% 82 7.20% 90 8.00%67 5.70% 75 6.50% 83 7.30%

Age Percentage Age Percentage Age Percentage Age Percentage

60 4.00% 68 4.80% 76 5.60% 84 6.40%61 4.10% 69 4.90% 77 5.70% 85 6.50%62 4.20% 70 5.00% 78 5.80% 86 6.60%63 4.30% 71 5.10% 79 5.90% 87 6.70%64 4.40% 72 5.20% 80 6.00% 88 6.80%65 4.50% 73 5.30% 81 6.10% 89 6.90%66 4.60% 74 5.40% 82 6.20% 90 7.00%67 4.70% 75 5.50% 83 6.30%

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Step-upOn each Policy Anniversary during the Withdrawal Period, the Withdrawal Payment Base will be compared to the annuity’s Account Value*. If the Account Value* is larger than the Withdrawal Payment Base, the Withdrawal Payment Base will Step-Up to the Account Value*.

Following the Step-Up, the Maximum Guaranteed Annual Withdrawal Payment is recalculated and increased, based on this higher Withdrawal Payment Base. These payments are guaranteed for your lifetime.

Example: At the end of two years of Withdrawal Payments, your annuity’s Account Value has grown to $132,725. Your Withdrawal Payment Base of $131,317 will Step-Up to $132,725. The Maximum Guaranteed Annual Withdrawal Payment will be increased to $9,025, which equals the Withdrawal Payment Base of $132,725 multiplied by the Guaranteed Withdrawal Percentage of 6.8%.



Additional WithdrawalsAn Additional Withdrawal is any withdrawal that is not a Withdrawal Payment and may be made at anytime during the Withdrawal Period. Additional Withdrawals reduce the Withdrawal Payment Base and Withdrawal Payments using the pro-rata adjustment factor. The pro-rata adjustment factor is based on the change in Account Value due to the Additional Withdrawal.

The Maximum Guaranteed Annual Withdrawal Payment will change to equal the Guaranteed Withdrawal Percentage multiplied by the Withdrawal Payment Base after the Additional Withdrawal. The new Maximum Guaranteed Annual Withdrawal Payment will become effective on the Policy Anniversary following the Additional Withdrawal.

Required Minimum Distributions (RMDs)If the RMD payment is greater than the Maximum Guaranteed Annual Withdrawal Payment, the additional amount withdrawn to meet the RMD payment will not be considered an Additional Withdrawal.

How Is The Maximum Guaranteed Annual Withdrawal Payment (MGAWP) Calculated?

Scenario 1 Scenario 2 Scenario 3

Age 65 - 1 Year Accumulation Age 65 - 5 Year Accumulation Age 65 - 10 Year Accumulation

Policy Years

Annuitants Age

Withdrawal Payment

Base

Guaranteed Withdrawal Percentage

MGAWPWithdrawal

Payment Base


MGAWPWithdrawal

Payment Base


MGAWP

0 65 100,000 100,000 100,000

1 66 104,000 5.60% 5,824 104,000 104,000

2 67 104,000 5.60% 5,824 108,160 108,160

3 68 104,000 5.60% 5,824 112,486 112,486

4 69 104,000 5.60% 5,824 116,986 116,986

5 70 104,000 5.60% 5,824 121,665 6.00% 7,300 121,665

6 71 104,000 5.60% 5,824 121,665 6.00% 7,300 126,532

7 72 104,000 5.60% 5,824 121,665 6.00% 7,300 131,593

8 73 104,000 5.60% 5,824 121,665 6.00% 7,300 136,857

9 74 104,000 5.60% 5,824 121,665 6.00% 7,300 142,331

10 75 104,000 5.60% 5,824 121,665 6.00% 7,300 148,024 6.50% 9,622

11 76 104,000 5.60% 5,824 121,665 6.00% 7,300 148,024 6.50% 9,622

12 77 104,000 5.60% 5,824 121,665 6.00% 7,300 148,024 6.50% 9,622

13 78 104,000 5.60% 5,824 121,665 6.00% 7,300 148,024 6.50% 9,622

14 79 104,000 5.60% 5,824 121,665 6.00% 7,300 148,024 6.50% 9,622

15 80 104,000 5.60% 5,824 121,665 6.00% 7,300 148,024 6.50% 9,622

This is a hypothetical example only. This example does not demonstrate an actual crediting scenario and is not a projection of the future results.

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Step-upOn each Policy Anniversary during the Withdrawal Period, the Withdrawal Payment Base will be compared to the annuity’s Account Value*. If the Account Value* is larger than the Withdrawal Payment Base, the Withdrawal Payment Base will Step-Up to the Account Value*.

Following the Step-Up, the Maximum Guaranteed Annual Withdrawal Payment is recalculated and increased, based on this higher Withdrawal Payment Base. These payments are guaranteed for your lifetime.

Example: At the end of two years of Withdrawal Payments, your annuity’s Account Value has grown to $132,725. Your Withdrawal Payment Base of $131,317 will Step-Up to $132,725. The Maximum Guaranteed Annual Withdrawal Payment will be increased to $9,025, which equals the Withdrawal Payment Base of $132,725 multiplied by the Guaranteed Withdrawal Percentage of 6.8%.



Additional WithdrawalsAn Additional Withdrawal is any withdrawal that is not a Withdrawal Payment and may be made at anytime during the Withdrawal Period. Additional Withdrawals reduce the Withdrawal Payment Base and Withdrawal Payments using the pro-rata adjustment factor. The pro-rata adjustment factor is based on the change in Account Value due to the Additional Withdrawal.

The Maximum Guaranteed Annual Withdrawal Payment will change to equal the Guaranteed Withdrawal Percentage multiplied by the Withdrawal Payment Base after the Additional Withdrawal. The new Maximum Guaranteed Annual Withdrawal Payment will become effective on the Policy Anniversary following the Additional Withdrawal.

Required Minimum Distributions (RMDs)If the RMD payment is greater than the Maximum Guaranteed Annual Withdrawal Payment, the additional amount withdrawn to meet the RMD payment will not be considered an Additional Withdrawal.




Policy Years

Annuitants Age

Withdrawal Payment

Base


MGAWPWithdrawal

Payment Base


MGAWPWithdrawal

Payment Base


MGAWP

0 65 100,000 100,000 100,000

1 66 104,000 5.60% 5,824 104,000 104,000

2 67 104,000 5.60% 5,824 108,160 108,160

3 68 104,000 5.60% 5,824 112,486 112,486

4 69 104,000 5.60% 5,824 116,986 116,986

5 70 104,000 5.60% 5,824 121,665 6.00% 7,300 121,665

6 71 104,000 5.60% 5,824 121,665 6.00% 7,300 126,532

7 72 104,000 5.60% 5,824 121,665 6.00% 7,300 131,593

8 73 104,000 5.60% 5,824 121,665 6.00% 7,300 136,857

9 74 104,000 5.60% 5,824 121,665 6.00% 7,300 142,331

10 75 104,000 5.60% 5,824 121,665 6.00% 7,300 148,024 6.50% 9,622

11 76 104,000 5.60% 5,824 121,665 6.00% 7,300 148,024 6.50% 9,622

12 77 104,000 5.60% 5,824 121,665 6.00% 7,300 148,024 6.50% 9,622

13 78 104,000 5.60% 5,824 121,665 6.00% 7,300 148,024 6.50% 9,622

14 79 104,000 5.60% 5,824 121,665 6.00% 7,300 148,024 6.50% 9,622

15 80 104,000 5.60% 5,824 121,665 6.00% 7,300 148,024 6.50% 9,622

This is a hypothetical example only. This example does not demonstrate an actual crediting scenario and is not a projection of the future results.

Page 6 Page 7

Example: A $20,000 withdrawal is made. The Account Value is $250,000 before the withdrawal. After the withdrawal the Account Value is $230,000, or 92% of the Account Value before the withdrawal. The Accumulation Period Withdrawal Payment Base is $240,000 before the withdrawal. It is multiplied by 92% and equals $220,800 after the Withdrawal.


During the Withdrawal PeriodThe Withdrawal Payment amount you choose to receive is guaranteed to be paid for your lifetime if it does not exceed the Maximum Guaranteed Annual Withdrawal Payment. The Maximum Guaranteed Annual Withdrawal Payment will remain level unless there is a Step-Up in the Withdrawal Payment Base, or you take an Additional Withdrawal.

You may receive your Withdrawal Payment annually, semi-annually, quarterly, or monthly. Each payment must be at least $100. Any election to start or stop withdrawal payments must be received at National Western Life Insurance Company® at least 20 days prior to the Policy Anniversary.

When the Withdrawal Period begins:• The Guaranteed Withdrawal Percentage is determined;• The Withdrawal Payment Base is increased to the annuity’s Account Value* if it is larger;• The Maximum Guaranteed Annual Withdrawal Payment is calculated;• Any outstanding loan must be repaid; • No more loans or Systematic Withdrawals of Interest from the Account Value of the policy may be taken;

and• Any applicable penalty-free withdrawal amount that is available each Policy Year under the base annuity

policy will be reduced by the Withdrawal Payment.




The Maximum Guaranteed Annual Withdrawal Payment equals the Withdrawal Payment Base multiplied by the Guaranteed Withdrawal Percentage.

Example: Five years ago, you purchased an annuity with Income Outlook with $100,000 and have now decided to begin Withdrawal Payments. The Withdrawal Payment Base is now $121,665 after five years of 4% interest and your Guaranteed Withdrawal Percentage is 6.8%. At this time, your Maximum Guaranteed Annual Withdrawal Payment is $8,273 and your annuity’s Account Value is $131,317. Therefore, the Withdrawal Payment Base is increased to the Account Value and your Maximum Guaranteed Annual Withdrawal Payment is $8,930.

$250,000- 20,000

$230,000

230,000 ÷ 250,000 = 92% $240,000x .92

$220,800


Account Value

ADDITIONAL DETAILSIssue AgesIncome Outlook may be added to the annuity at purchase, regardless of age.


AnnuitantsThe annuitant and joint annuitant, if any, cannot be changed after the annuity is issued.


Guaranteed Withdrawal PercentagesThe Guaranteed Withdrawal Percentage is based on your age on the Policy Anniversary that you begin Withdrawal Payments.

The table below has the Guaranteed Withdrawal Percentages when there are joint annuitants. The percentage is based on the age of the younger annuitant on the Policy Anniversary that you begin Withdrawal Payments.

Age Percentage Age Percentage Age Percentage Age Percentage60 5.00% 68 5.80% 76 6.60% 84 7.40%61 5.10% 69 5.90% 77 6.70% 85 7.50%62 5.20% 70 6.00% 78 6.80% 86 7.60%63 5.30% 71 6.10% 79 6.90% 87 7.70%64 5.40% 72 6.20% 80 7.00% 88 7.80%65 5.50% 73 6.30% 81 7.10% 89 7.90%66 5.60% 74 6.40% 82 7.20% 90 8.00%67 5.70% 75 6.50% 83 7.30%

Age Percentage Age Percentage Age Percentage Age Percentage

60 4.00% 68 4.80% 76 5.60% 84 6.40%61 4.10% 69 4.90% 77 5.70% 85 6.50%62 4.20% 70 5.00% 78 5.80% 86 6.60%63 4.30% 71 5.10% 79 5.90% 87 6.70%64 4.40% 72 5.20% 80 6.00% 88 6.80%65 4.50% 73 5.30% 81 6.10% 89 6.90%66 4.60% 74 5.40% 82 6.20% 90 7.00%67 4.70% 75 5.50% 83 6.30%

Page 5Page 8

During the Accumulation PeriodThe Accumulation Period Withdrawal Payment Base has a 4% interest rate that is guaranteed each year during the Accumulation Period. The Accumulation Period Withdrawal Payment Base initially equals the premium paid, plus any applicable premium bonus. Additional premiums paid and premium bonuses, if applicable, will be added to the Accumulation Period Withdrawal Payment Base when they are received. Withdrawals made from the Account Value will reduce the Accumulation Period Withdrawal Payment Base.



• The 4% guaranteed interest rate on the Accumulation Period Withdrawal Payment Base will beguaranteed from Restart;

• The Accumulation Period Withdrawal Payment Base will be increased to the annuity’s Account Value*, if larger; and

• The Annual Rider Charge Rate may change, but will not be higher than the maximum guaranteed charge of 1%.

You must wait five years after each Restart before beginning a new Accumulation Period.



WithdrawalsWithdrawals may be made at anytime as provided by the annuity. Withdrawals from your annuity will reduce the Accumulation Period Withdrawal Payment Base by the same percentage reduction made to the annuity’s Account Value.

Issue Age


1 2 3 4 5 6 7 8 9 10

60 $5,304 $5,624 $5,962 $6,317 $6,692 $7,086 $7,501 $7,938 $8,398 $8,881 61 $5,408 $5,732 $6,074 $6,434 $6,813 $7,212 $7,632 $8,075 $8,540 $9,029 62 $5,512 $5,841 $6,187 $6,551 $6,935 $7,339 $7,764 $8,211 $8,682 $9,178 63 $5,616 $5,949 $6,299 $6,668 $7,057 $7,465 $7,896 $8,348 $8,825 $9,326 64 $5,720 $6,057 $6,412 $6,785 $7,178 $7,592 $8,027 $8,485 $8,967 $9,474 65 $5,824 $6,165 $6,524 $6,902 $7,300 $7,718 $8,159 $8,622 $9,109 $9,622 66 $5,928 $6,273 $6,637 $7,019 $7,422 $7,845 $8,290 $8,759 $9,252 $9,770 67 $6,032 $6,381 $6,749 $7,136 $7,543 $7,972 $8,422 $8,896 $9,394 $9,918 68 $6,136 $6,490 $6,862 $7,253 $7,665 $8,098 $8,554 $9,033 $9,536 $10,066 69 $6,240 $6,598 $6,974 $7,370 $7,787 $8,225 $8,685 $9,169 $9,679 $10,214 70 $6,344 $6,706 $7,087 $7,487 $7,908 $8,351 $8,817 $9,306 $9,821 $10,362 71 $6,448 $6,814 $7,199 $7,604 $8,030 $8,478 $8,948 $9,443 $9,963 $10,510 72 $6,552 $6,922 $7,312 $7,721 $8,152 $8,604 $9,080 $9,580 $10,106 $10,658 73 $6,656 $7,030 $7,424 $7,838 $8,273 $8,731 $9,212 $9,717 $10,248 $10,806 74 $6,760 $7,139 $7,537 $7,955 $8,395 $8,857 $9,343 $9,854 $10,390 $10,954 75 $6,864 $7,247 $7,649 $8,072 $8,517 $8,984 $9,475 $9,991 $10,533 $11,102 76 $6,968 $7,355 $7,762 $8,189 $8,638 $9,110 $9,606 $10,127 $10,675 $11,250 77 $7,072 $7,463 $7,874 $8,306 $8,760 $9,237 $9,738 $10,264 $10,817 $11,398 78 $7,176 $7,571 $7,987 $8,423 $8,882 $9,363 $9,869 $10,401 $10,960 $11,546 79 $7,280 $7,679 $8,099 $8,540 $9,003 $9,490 $10,001 $10,538 $11,102 $11,694 80 $7,384 $7,788 $8,212 $8,657 $9,125 $9,616 $10,133 $10,675 $11,244 $11,842 81 $7,488 $7,896 $8,324 $8,774 $9,247 $9,743 $10,264 $10,812 $11,386 $11,842 82 $7,592 $8,004 $8,436 $8,891 $9,368 $9,869 $10,396 $10,949 $11,386 $11,842 83 $7,696 $8,112 $8,549 $9,008 $9,490 $9,996 $10,527 $10,949 $11,386 $11,842 84 $7,800 $8,220 $8,661 $9,125 $9,612 $10,123 $10,527 $10,949 $11,386 $11,842 85 $7,904 $8,328 $8,774 $9,242 $9,733 $10,123 $10,527 $10,949 $11,386 $11,842

$100,000 Premium – Maximum Guaranteed Annual Withdrawal Payments

Page 4 Page 9

INCOME OUTLOOK DETAILSIncome Outlook is available to add as a rider to your National Western Life equity indexed annuity only at the time of purchase.

The Withdrawal Payment is the amount you choose to receive each year. The Maximum Guaranteed Annual Withdrawal Payment is guaranteed to be paid for your lifetime if no Additional Withdrawals are taken. Your age must be at least 60 before Withdrawal Payments may begin. You may begin taking Withdrawal Payments as early as the first Policy Anniversary or any Policy Anniversary you choose after that. The Withdrawal Payments taken under this rider are deducted from the annuity’s Account Value and will not incur any withdrawal charges.

There is an Annual Rider Charge for this benefit on each Policy Anniversary, beginning with the first. The Annual Rider Charge Rate is determined on the Policy Date and is shown on page 1 of the rider. This rate is guaranteed not to change while this rider is in force unless Restart (as described below) is elected and will never exceed the maximum rate of 1.00%. The Annual Rider Charge will never exceed, the smaller of:

1) the Annual Rider Charge Rate times the AccountValue on the Policy Anniversary, prior to any interestcredits; or

2) the Interest Credits on the Account Value for thePolicy Year.

In other words, the Annual Rider Charge will not reduce the annuity’s Account Value by more than the interest credits for that Policy Year.

The rider has two periods, the Accumulation Period and the Withdrawal Period. Each period is described as follows.

CancellationYou may cancel this rider at anytime. The rider will terminate when the annuity terminates for any reason or when the Maximum Guaranteed Annual Withdrawal Payment is less than $100.

CONCLUSIONIncome Outlook from National Western Life provides the security of a guaranteed income stream you can not outlive in retirement. This rider also offers the opportunity for larger income benefits when indexed interest credits increase your annuity’s Account Value. It also gives you control of your annuity as your needs change and access to your money if needed.

About the CompanyNational Western Life Insurance Company® is a Colorado corporation with executive offices in Austin, Texas. The Company offers a full line of life insurance and annuity products (both on an individual and group basis), through independent agency offices in 49 states and the District of Columbia, and accepts applications from residents of several foreign countries. Visit our website www.nationalwesternlife.com for all current financial information.


Page 3Page 10

NWL®’s Income Outlook provides:

• Great growth potential for your lifetime Withdrawal Payments...

• Control of when your Withdrawal Payments begin...

• Guaranteed Withdrawal Percentages that increase every year...

• Access to your money for Additional Withdrawals remains...

• Guaranteed Withdrawal Payments for life anytime after the age of 60!

Adding Income Outlook to your National Western Life equity indexed annuity at purchase will give you all of these benefits. This withdrawal benefit rider works with all of your annuity’s traditional benefits and enhances the benefits with guaranteed Withdrawal Payments you cannot outlive.

INCOME OUTLOOK HIGHLIGHTSIncome Outlook guarantees during the Accumulation Period:

• 4% interest on the Accumulation Period Withdrawal Payment Base until lifetime WithdrawalPayments begin

• The Guaranteed Withdrawal Percentages increase every year until age 90 or until the lifetimeWithdrawal Payments begin

• Access to the annuity’s Account Value remains• The option to Restart the ten year Accumulation Period at the end of the fifth Policy Year

Income Outlook guarantees during the Withdrawal Period:• Withdrawal Payments that can be paid for life• The ability to stop and start Withdrawal Payments• No withdrawal charges on Withdrawal Payments taken under this rider• The Withdrawal Payment Base to Step-Up to the annuity’s Account Value*, if larger, when the

Withdrawal Period begins and each Policy Anniversary thereafter• The Maximum Guaranteed Annual Withdrawal Payment increases each time there is a Step-Up in the

Withdrawal Payment Base• Access to the annuity’s Account Value remains• Required Minimum Distribution friendly

*If the base annuity policy has a premium bonus that is not included in the Account Value, then for purposes of Restart, Step-Up, and

Withdrawal Payment Base, the Account Value will be increased by any applicable base annuity Vested Bonus Value.

INCOME OUTLOOK

NWL®’s Withdrawal Benefit Rider Enjoy the benefits of guaranteed lifetime retirement income with enhanced accumulations and control of your annuity!

National Western Life requires that the Agent review this entire brochure with you.






















A Flexible Premium Deferred

Equity Indexed Annuity For

Long Term Accumulation

Consumer Information Summary

and Disclosure Brochure

Policy Form 01-1135-04 and state

variations thereof

DM-1109.Rev.7.12

Protect your hard-earned money!

You may choose the advantage of

in terest accumulat ion based on a formula l inked in

par t to an index!

U L T RC L A S S I C

NWL

This Consumer Information Summary and Disclosure Brochure is not part of the Policy and does not modify the Policy in any way.


850 East Anderson Lane

Austin, Texas 78752

®

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A

Because Americans are living longer and want more satisfying lifestyles during retirement, safe retirement plan-ning is more important today than ever before. It is likely that Social Security and most employer-sponsoredqualified retirement plans won’t be enough. As a result, you will have to meet part of the challenge with yourown savings and money management efforts. The NWL Ultra Classic® Annuity might be right for you! Anannuity is a long-term product designed as an appropriate planning vehicle for retirement security, and can provide you with a series of payments over a period of time.

The information in this disclosure brochure will explain the benefits and features of this annuity, and it is to yourbenefit to read it. Like any annuity issuer, National Western incurs expenses to sell and issue its annuity policies, including compensation to its agents, bonus amounts and/or additional interest (if applicable), optioncosts, and various other expenses, and these expenses are taken into consideration when interest rates, caps, andparticipation rates are established and reset. You will receive all benefits as set forth in the contract.

To help you fully understand what the NWL Ultra Classic® Annuity has to offer, National Western requires thatyour Agent review this disclosure brochure with you so that you may ask any questions that you may have. Youmay also call National Western’s Domestic Marketing Department at 1-800-760-3434 if you have any questions.National Western Life offers a wide variety of annuity products with different benefits, features, and limitations.Please ask your agent for more information.

About the Company

National Western Life Insurance Company® is a Colorado corporationwith Executive Offices in Austin, Texas. The Company offers a full lineof life insurance and annuity products (both on an individual and groupbasis), through general agency offices in 49 states and the District ofColumbia. Visit our website www.nationalwesternlife.com for all currentfinancial information.

Since its start in 1956, National Western has emphasized financialstrength for the protection of its policyholders. As a legal reserve insur-ance company, National Western must set aside a portion of its assetsequal to reserves required by law. Annually, a financial statement is filedwith each state’s insurance department. These departments have theauthority to verify, through reviews and audits, that the appropriatereserves are maintained.

What Protection am I Receiving on My Financial Outlay?

When planning for retirement, or while in retirement, security, stability,financial independence, and peace of mind are important factors you probably desire. The NWL Ultra Classic® Annuity allows you to takeadvantage of a monthly average or monthly index changes of the S&P500® Index. A downturn in the S&P 500® Index alone cannot have a negative impact on the financial outlay of your NWL Ultra Classic®

Annuity Policy. With the NWL Ultra Classic® Annuity, you can make the most of your retirement and take control of your hard-earned money.

What is the NWL Ultra Classic® Annuity?

The NWL Ultra Classic® Annuity is a flexible premium tax-deferred annuity that combines the safety, benefits, and features of

traditional fixed interest deferred annuities while at the same timegiving you the option of having your credited interest linked in part to the

S&P 500® Composite Stock Index (which excludes dividends). Once credited, your gains are guaranteed for the life of the policy!

Enjoy peace of mind with these exceptional benefits:

• You have the opportunity to have interest accumulation based on a formula linkedin part to the S&P 500® Composite Stock Index (which excludes dividends).

• Your credited gains are locked in each year and cannot be taken away due to future market performance alone.*

• Your financial outlay is never exposed to market risk and is never reduced because of market fluctuation alone.* You enjoy an increase, if any, based on the S&P 500® Index monthly average or

monthly index changes over each Policy Year according to your allocation percentage.

*See description of available Withdrawal Benefit Riders and their associated charges for any impact they might have on the values in your Policy.

What are the Tax Advantages?

Because income taxes are deferred until funds are with-drawn, interest is earned on dollars that might otherwisebe paid in taxes. This results in greater financial growththan might be possible in a taxable savings instrument.

In addition to deferring income taxes, you may exercisesome control over the ultimate timing of income taxation.Taxes are imposed when funds are withdrawn or paid asa regular income. For the most part, you select thetime funds are withdrawn and, therefore, when youare taxed. More importantly perhaps, you can select anincome settlement option and spread the taxes payableover a number of years. Withdrawals before the owneris 591⁄2 may be subject to a 10% income tax penalty.

The graph to the right is intended only to illustrate theadvantages of tax-deferred growth. Compared are valuespaying income taxes annually, deferring all incometaxes, and paying taxes one time at the end of the peri-od shown. The values represented are not guaranteed.The interest credited to your annuity may be higher orlower and is subject to change. Actual results may bemore or less. Non-qualified funds withdrawn are taxedas interest out first. Withdrawals before the owner is591⁄2 may be subject to a 10% income tax penalty.Income tax deferral is provided by any tax-qualifiedretirement plan. As such, the tax-deferred feature of aqualified annuty is redundant. Note that only anannuity can provide an income that cannot be out-lived.

10 Years 20 Years 30 Years

An Illustration of Tax-Deferred Growth

The graph below is an illustration of the advantages of

tax-deferred growth. It assumes a one-time $10,000

premium contribution compounding at 6.0% into any

instru ment that is currently taxable at 28% versus any

instrument such as an annuity on which taxes are cur-

rently deferred.

60,000

50,000

40,000

30,000

20,000

10,000

Growth Taxable Annually

Deferred Accumulation Pre Tax

Deferred Accumulation After Tax

U L T RC L A S S I C

NWL

®

2 of 10

3 of 10

the Contract Term, the Minimum GuaranteedInterest Rate will be re-determined.

The Cash Surrender Value of your policy is theAccount Value less the withdrawal charge, if applicable, or the Minimum Guaranteed ContractValue, whichever is greater.

*Information about withdrawal charges is provided in detaillater in this disclosure brochure. See description of availableWithdrawal Benefit Riders for more information regardingrider charges and benefits.

Do I Have A Choice of Different InterestOptions?

Yes. The annuity owner can choose one of three different methods or strategies by which to earn interest. These three strategies, Interest Credit OptionsA, B, and D, are available at issue. Options A and Dmay not be available on renewal. Any current InterestCredit Option is effective for the full Policy Year. Theseinterest options are as follows:

Option A Equity Indexed Interest-AnnualRatchet with Monthly Average:Interest on the Account Value is linked in partto the S&P 500® Index. (Note: The indexdoes not include dividends that may be paidon the stocks making up the index.) OptionA Indexed Interest is not earned or crediteduntil the Policy Anniversary. Until the PolicyYear is over and the necessary 12 monthlyIndex Values are available, the Option A formula cannot be calculated.

Option B Fixed Interest Rate:The interest rate on the portion of theAccount Value allocated to Interest CreditOption B is declared in advance by NWL®

and is guaranteed for the first Policy Year.This interest rate is located on page three ofthe Policy and includes first-year only addi-tional interest of 1.40%. The interest rate inthe first Policy Year will likely be higher thanthe interest rate in subsequent Policy Years.After the first Policy Year, these interest rateswill be declared from time to time and aresubject to change.

Option D Equity Indexed Interest AnnualRatchet with Monthly Cap: Interest on theAccount Value is linked in part to the S&P

How Much Initial Money Must I Contribute,and Can I Add More Money Later?

You can get all the benefits offered by the NWL UltraClassic® Annuity with a minimum initial premium of$5,000 non-qualified and $2,000 qualified. The InitialPremium includes payments up to 20 days from issue.After that you may add premium payments of at least$100 at any time, which will earn a non-indexed fixedinterest rate until the next Policy Anniversary whenthose premiums and the interest earned will be addedto the Account Value (defined below) for creditingunder the Interest Credit Option selected for the nextPolicy Year. There is no better way to build a substan-tial retirement asset than by making regular ongoingpayments.

What are the Values of my Policy?

The Contract Value is the greater of the AccountValue or the Minimum Guaranteed Contract Value.

The Account Value is equal to the premiums received,less any withdrawals and withdrawal charges* on suchwithdrawals, and less any applicable rider charges and

benefits*, accumulated withinterest, and, if any, applic-

able Federal, State, orMunicipal taxes, or

any fees or assess-ments required bylaw. Such interestis based on theInterest Credit

Option(s) that you have elected.

Regardless of theInterest Credit Option(s)

you select or the S&P 500®

Index performance, the Minimum GuaranteedContract Value you will receive will never be less than87.5% of premiums received, less withdrawals andwithdrawal charges, accumulated at the MinimumGuaranteed Interest Rate.

The Minimum Guaranteed Interest Rate is set fornew policies each calendar quarter. It is the average ofthe 5 Year Constant Maturity Treasury Rate minus1.25% for the 6 month period ending 1 month priorto the beginning of the current calendar quarter. It isnever less than 1.00%, never greater than 3.00%, andis guaranteed for the Contract Term. At the end of

4 of 10

year. All indexed interest is credited annually on thePolicy Anniversary and locked-in. Future decreases inthe Index will never reduce your financial outlay.

Monthly Averaging – National Western Life averagesthe S&P 500® Index Values corresponding to the 12Index Dates each Policy Year. The Index Date is the same day eachmonth as the day immediatelybefore the Policy Date atissue. For example, ifthe Policy Date isAugust 10th, NWL®

will average theIndex Value for the9th day of eachmonth beginningwith September 9thand concluding for thatyear with the next August9th. The Index Value on thePolicy Date is the opening value of the Index on thatdate. The Index Value on subsequent Index Dates isthe closing value of the Index on that date.

Participation Rate – The Participation Rate at issue isguaranteed for the first Policy Year only, as declared byNational Western Life. The Participation Rate for subsequent Policy Years is declared on each PolicyAnniversary for the following Policy Year. TheParticipation Rate will likely be higher in the first PolicyYear than in subsequent Policy Years. The ParticipationRate in subsequent Policy Years is not guaranteed andmay be lower than the first Policy Year based on a num-ber of factors, including but not limited to, dividendyields, stock market volatility, and new money interestrate levels. The guaranteed Minimum ParticipationRate is 50% in all available states.

Asset Fee Rate – A first year Asset Fee Rate is declaredat issue. The Asset Fee Rate will be deducted only inthe calculation of Option A equity indexed interest andwill never exceed 6.00%. The Asset Fee Rate for subse-quent Policy Years is declared each year on the PolicyAnniversary and will likely be higher than the first yearAsset Fee Rate. The Asset Fee Rate for subsequentPolicy Years may fluctuate from year to year as it isinfluenced by a number of factors, including but notlimited to, dividend yields, stock market volatility, andnew money interest rate levels. The Asset Fee Rate isnot guaranteed and may be subject to change.

500® Index. (Note: The index does notinclude dividends that may be paid on thestocks making up the index.) Option DIndexed Interest is not earned or credited untilthe Policy Anniversary. Until the Policy Year is over and the necessary 12 monthly IndexValues are available, the Option D formulacannot be calculated.

You may elect to allocate the premium to more thanone Interest Credit Option. The Interest CreditAllocation Percentages for available Interest CreditOptions can be any whole number percentages, in any combination, whose total is 100%.

After My Annuity is Issued, May I Changeto a Different Interest Option?

Yes. The annuity owner may change to any of the available interest methods for the next Policy YearPRIOR to the Policy Anniversary. A pre-anniversarynotice is mailed to the annuity owner 30 days prior tothe Policy Anniversary. To change from the currentinterest option, he/she is instructed to complete thebottom of the notice, detach it, and mail it back toNational Western Life. The notice must be receivedat our office at least 5 business days prior to thePolicy Anniversary for it to be effective for the following Policy Year. If we do not receive notifica-tion of a new election within the time period allowed,the previous interest option, if available, will remain in effect.

How is the Equity Indexed InterestCalculated?

The NWL Ultra Classic® Annuity has two equityindexing methods. Option A offers an Annual Ratchet feature, Monthly Averaging, first year andrenewal year Participation Rates, and first year andrenewal year Asset Fee Rates. Option D offers anAnnual Ratchet feature, a Monthly Index Change Rate,and a Monthly Index Cap Rate. There is no AssetFee Rate or Participation Rate on Option D.

Let’s take a closer look at how these two optionswork.

OPTION A

Annual Ratchet – Any indexed interest earned is calculated from the beginning Index Value for eachPolicy Year, whether higher or lower than the previous

Option D Monthly

Index Date Index Value Index Change Rate

1/6 880

2/6 850 -3.41%

3/6 840 -1.18%

4/6 860 2.00%

5/6 920 2.00%

6/6 960 2.00%

7/6 980 2.00%

8/6 980 0.00%

9/6 1000 2.00%

10/6 1020 2.00%

11/6 1050 2.00%

12/6 1070 1.90%

1/6 1110 2.00%

expected to be higher in the First Policy Year than insubsequent Policy Years. The interest is credited annual-ly on the Policy Anniversary to the Account Value atthe beginning of that Policy Year.

Annual Ratchet – The indexed interest earned, if any,is calculated from the beginning Index Value for eachPolicy Year, whether higher or lower than the previousPolicy Year. All indexed interest is credited annuallyand locked-in. Future decreases in the Index willnever reduce your financial outlay.

Hypothetical Interest Crediting Example -Option D

Assumed Policy Date: January 7

Account Value(Includes any premiums received on orbefore the 20th Calendar day followingthe Policy Date) ..........................................$50,000

Index Value on Policy Date ......................................880

Monthly Index Cap Rate ......................................2.00%

Interest Rate Credited(Sum of Monthly Change Rates fromexample above) ............................................13.31%

Multiply by Account Value ..................................$6,655

New Account Value ..........................................$56,655

Note: This example is strictly hypothetical and intended to demonstrate only the Option D formula. Example assumes 100%allocation to Option D.

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Equity Indexed Interest Credit Option AFormula:

([( A / B ) x C ] - D) x E

A - Index Average for the current Policy Year minusthe Index Value on the Prior Anniversary or PolicyDate (if Policy is in the first year).

B - Index Value on the prior Anniversary or PolicyDate (if Policy is in the first year).

C - Participation Rate for the Policy Year expressed asa decimal number (100% is 1.0)

D - Asset Fee Rate for the Policy Year expressed as decimal number (2% is .02).

E - In the first Policy Year, the initial premium pluspremiums received on or before the 20th calendarday following the Policy Date; in Policy Years afterthe first, the Account Value on the prior PolicyAnniversary.

Where the formula result is zero or less, the interestcredited on the Option A portion of your AccountValue will be zero.

[See Hypothetical Interest Crediting Examples forOption A on page 6]

OPTION D

Monthly Index Change Rate – The calculation of the percentage change, either positive or negative, ismonthly from Index Date to Index Date. The Index

Date is the last day of eachmonthly period beginning

on the Policy Date andthe same day of each

month thereafter.

Monthly IndexCap Rate – Theinterest rate will bethe sum of monthly

percentage increasesand decreases in the

index, but the rate credit-ed will not be less than zero

(0%). Any single monthly increasewill be limited to no greater than the Monthly IndexCap Rate, declared in advance annually. The MonthlyIndex Cap Rate will never be less than 1% and is

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Example 1 Example 2

Initial Premium $50,000 $50,000

(Includes any premiums received on or

before the 20th calendar day following the

Policy Date) (E)

Index Value on Policy Date (B) 850 920

Index Average (Sum /12 from below) 978.8 912.1

Index Average minus

Index Value (A) 128.8 (7.9)

Divide Difference (A)

by Index Value (B) 0.152 (0.009)

First Year Participation Rate (C) 100% 100%(1.0 as decimal) (1.0 as decimal)

Multiply by Participation Rate (C) 0.152 (0.009)

First Year Asset Fee Rate (D) 2% 4%(.02 as decimal) (.04 as decimal)

Less Asset Fee Rate Above 0.132 (0.049)

Multiply by Premiums (E) $6,600 ($2,450)

Interest Credited under Option A $6,600 $0

Annual Percentage Rate Credited 13.2% 0%

Example 1 Example 2

Policy Date: February 5 Policy Date: May 12

Index Date Index Value Index Date Index Value

3/4 840 6/11 845

4/4 850 7/11 880

5/4 910 8/11 900

6/4 950 9/11 910

7/4 980 10/11 900

8/4 980 11/11 920

9/4 1000 12/11 915

10/4 1010 1/11 900

11/4 1030 2/11 910

12/4 1050 3/11 950

1/4 1060 4/11 975

2/4 1085 5/11 940

Sum of Values 11,745 Sum of Values 10,945

Average 978.8 Average 912.1

Examples at the END of the FIRSt Policy Year

Example 3 Example 4

Account Value (E) $50,000 $50,000

Index Value on PriorPolicy Date (B) 900 890

Index Average (Sum /12 below) 954.3 991.2

Index Average minusIndex Value (A) 54.3 101.2

Divide Difference (A) by Index Value (B) 0.060 0.114

Renewal Year Participation Rate (C) 70% 70%

(0.7 as decimal) (0.7 as decimal)

Multiply by Participation Rate (C) 0.042 0.08

Renewal Year Asset Fee Rate (D) 3% 3%

(0.03 as decimal) (0.03 as decimal)

Less Asset Fee Rate Above 0.012 0.05

Multiply by Acct.Value (E) $600 $2,500

Interest Credited underOption A $600 $2,500

Annual Percentage Rate Credited 1.2% 5.0%

Example 3 Example 4

Policy Date: October 10 Policy Date: November 4

Index Date Index Value Index Date Index Value

11/9 934 12/3 850

12/9 900 1/3 896

1/9 887 2/3 890

2/9 870 3/3 920

3/9 920 4/3 996

4/9 900 5/3 980

5/9 960 6/3 1000

6/9 996 7/3 1040

7/9 1000 8/3 1050

8/9 1003 9/3 1035

9/9 1036 10/3 1089

10/9 1046 11/3 1148

Sum of Values 11,452 Sum of Values 11,894

Average 954.3 Average 991.2

Examples on a Policy ANNIVERSARY after the First

Hypothetical Interest Crediting Examples - Option A

Note: These examples are strictly hypothetical and intended to demonstrate only the Option A formula.The abbreviations used in the formulaand examples (e.g., A, B, C, D, etc.) may differ from the abbreviations used in the actual Interest Credit Option Endorsements. TheParticipation Rate and Asset Fee Rate, both first year and renewal years, are assumed for purposes of this example. Example assumes 100% allocation to Option A.

Withdrawal Options Available to Avoid Withdrawal Charges

• 10% Penalty-Free Withdrawals each Policy Year after the first, cumulative to 50%• Systematic Interest Withdrawals each Policy Year after the first• IRA Qualified Required Minimum Distribution in all Policy Years• Waiver of Withdrawal Charge after Qualifying Medical Stay• Terminal Illness Benefit • 60% Policy Loan (Interest Option B Only) • Annuitization of Policy starting after the 5th Policy Anniversary

Penalty-Free Partial Withdrawals or Systematic Interest Withdrawals – Once each year, after the 1st Policy Year, youmay take up to a 10% penalty-free withdrawal, cumulative to 50% of the Account Value (“penalty-free” means no with-drawal charges), OR if you prefer, you may elect to make withdrawals of interest earnings without withdrawal charges,limited to the annual amount of interest credited during the prior Policy Year. However, if you should decide to fully sur-render this annuity within 12 months of having taken a penalty-free or systematic interest withdrawal, you will incur aretroactive withdrawal charge on that amount at the time of full surrender.

IRA Qualified Withdrawal – If you have reached the age of 701/2, you may need to begin taking Required MinimumDistributions (RMD) if your NWL Ultra Classic® Annuity is issued as a tax-qualified plan. Beginning in the first PolicyYear, the RMD may be taken penalty-free. See Endorsement Form 01-4336-03.

Remember, all withdrawals are subject to federal income tax. Withdrawals prior to age 591⁄2 may be subject to an additional 10% income tax penalty, and if a trust is named as the owner, such withdrawals may be subject to this additional 10% income tax penalty regardless of age.

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What If, After the Annuity is Issued, I Have to Make a Withdrawal? What are my Options?

With the NWL Ultra Classic® Annuity, you have flexibility and a number of liquidity options.

Withdrawal ChargesThis is a long term accumulation annuity. So that National Western Life can provide these accumulation benefits, most ofthe premium is invested for the long term.

If, after the 1st Policy Year, you exceed the 10% penalty-free withdrawal amount explained in the following section, or yousurrender this annuity before the end of the 13th Policy Year (unless you take a settlement option after the 5th PolicyYear), or you make withdrawals in the 1st Policy Year (with the exception of an IRA Qualified Required MinimumDistribution, Endorsement 01-4336-03) you will incur withdrawal charges. Interest is charged on any withdrawal fromthe processing date to the next Option Term End Date, if under Option A or D. The withdrawal charge rates by PolicyYear are as follows:

Policy Issue Issue Issue Issue Issue Issue Issue Issue Issue IssueYear Ages 0-51 Age 52 Age 53 Age 54 Age 55 Age 56 Age 57 Age 58 Age 59 Ages 60 -80

1 15.00% 15.00% 14.25% 13.25% 12.50% 11.75% 12.50% 13.50% 14.50% 15.00%2 14.75% 14.25% 13.25% 12.50% 11.75% 10.75% 11.75% 12.75% 13.75% 14.75%3 14.00% 13.25% 12.50% 11.75% 10.75% 10.00% 11.00% 11.75% 12.75% 14.00%4 13.00% 12.50% 11.75% 10.75% 10.00% 9.00% 10.00% 11.00% 12.00% 13.00%5 12.25% 11.75% 10.75% 10.00% 9.00% 8.25% 9.25% 10.25% 11.25% 12.25%6 11.25% 10.75% 10.00% 9.00% 8.25% 7.25% 8.25% 9.25% 10.25% 11.25%7 10.50% 10.00% 9.00% 8.25% 7.25% 6.50% 7.50% 8.50% 9.50% 10.50%8 9.75% 9.00% 8.25% 7.25% 6.50% 5.50% 6.50% 7.50% 8.50% 9.75%9 8.75% 8.25% 7.25% 6.50% 5.50% 4.50% 5.50% 6.50% 7.75% 8.75%

10 8.00% 7.25% 6.50% 5.50% 4.50% 3.75% 4.75% 5.75% 6.75% 8.00%11 6.00% 6.00% 5.50% 4.50% 3.75% 2.75% 3.75% 4.75% 6.00% 6.00%12 4.00% 4.00% 4.00% 3.75% 2.75% 1.75% 2.75% 4.00% 4.00% 4.00%13 2.00% 2.00% 2.00% 2.00% 1.75% 0.75% 2.00% 2.00% 2.00% 2.00%

Withdrawal Charge Rates

Note: Withdrawal charge rates are calculated individually at certain issue ages to comply with nonforfeiture laws.

8 of 10

must be paid annually at 7.4% in advance. If not, theinterest will be added to the amount of the loan. Also,cash loans are not available for IRAs or Roth IRAs or forsome other qualified plans.

If any loan amount is owed to us when a settlementoption is elected or upon the Annuitant’s death,whichever occurs first, such amount will be treated as a partial withdrawal and will be subject to withdrawalcharges.

See endorsements for complete information; certainlimitations and exclusions may apply.

Income Settlement Options at Annuity Date – Youmay elect to receive the Contract Value under anIncome Settlement Option on the Annuity Date. Youmay choose an Annuity Date that occurs as early as theend of the 5th Policy Anniversary. At this time youmay elect to receive payments under one of the manyavailable options, including but not limited to:• Income for a specific number of years (minimum of

5), or• Income for as long as you live, or• Income for as long as you and your joint annuitant

live.

A guaranteed interest rate of 1.75% will be used in calculating these payments. National Western Lifemay, at its option, use an interest rate that is higherthan the guaranteed rate. See the Policy for completedetails of these options.

What Happens If I Keep My Annuity for13 Years and am Still Not Ready to Takethe Money Out? At the end of the 13-year Contract Term, you maywithdraw the full Contract Value without any with-drawal charges, take a partial withdrawal, or elect anincome settlement option.You do have the right to keep the Account Value withNational Western Life for the rest of your life where itwill continue to earn interest at a rate not less than theMinimum Guaranteed Interest Rate that has been re-determined at the end of your Contract Term.

What Will Happen if the Annuitant Dies?

The NWL Ultra Classic® Annuity provides a death benefit payable to the named Beneficiary. If theAnnuitant’s death occurs before the Annuity Date, theBeneficiary will receive the Contract Value as a singlesum, OR the Beneficiary can elect to receive theContract Value applied under one of the IncomeSettlement Options. If the Annuitant dies on or after the

Waiver of Withdrawal Charge after QualifyingMedical Stay – You may withdraw up to 75% of theAccount Value without withdrawal charge after certainmedically necessary stays as outlined in the Policy. TheAnnuitant must be 75 years or younger on the PolicyDate, and each stay must be for at least 90 consecutivedays. The stay must be in a hospital and/or nursingfacility (as defined in the Policy), and the Annuitantmust receive at least intermediate care (as described inthe Policy) for 90 consecutive days during the stay.The stay must begin at least 180 days after the PolicyDate and must not be for a medical condition thatinvolved a prior stay of any length in the two-year period before the Policy Date. The stay must not havebeen recommended by a physician in the two-yearperiod before the Policy Date. Any withdrawal inexcess of 75% of the Account Value will be subject tothe Policy’s regular withdrawal charge. See Policy forcomplete details and requirements.

Please note: Only one of the four aforementionedoptions may be elected in the same Policy Year.

Terminal Illness Benefit – If the Annuitant shouldface the unexpected and be diagnosed with an illnessfrom which the Annuitant is not expected to recover,and the annuitant is expected to die within twelve (12)months, withdrawal charges will be waived for a fullsurrender or partial withdrawal. Satisfactory documen-tation of the Terminal Illness is required, and theCompany reserves the right to obtain a second medical opinion at the Company’s expense. See Policy for complete details and requirements.

Cash Loan Privilege – Endorsement Form 01-4087XP

Starting the 2nd Policy Month, a policy loan for aminimum of $500 may be taken for up to 60% of theContract Value (greater of the Account Value or theMinimum Guaranteed Contract Value) if the InterestCredit Allocation Percentage for Interest Credit Option B is 100%. (In Vermont and Virginia the loan privilege is Endorsement Form 01-4087P-VA.Starting the 4th Policy Year, a policy loan may be taken for up to 100% of the Cash Surrender Value ifthe Interest Credit Allocation Percentage for InterestCredit Option B is 100%.)

Loans are not available if Interest Credit Option A orInterest Credit Option D is in effect. In addition, any loan would have to be repaid before Interest CreditOption A or Interest Credit Option D could be elected.All or part of a loan may be repaid at any time, but eachpayment must be at least $25. The interest on the loan

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of the benefits and features of these riders and applicablecharges.

Annual ReportEach Policy Year, you will receive an annual report.The detailed status will show the following:

• Premium received during the Policy Year• Withdrawals during the Policy Year• Interest credited during the Policy Year• Account Value• Contract Value• Cash Surrender Value

Legal and Tax AdviceNational Western Life does not authorize its agents oremployees to give legal or tax advice.

Representations made in this disclosure brochure arebased on our understanding of current tax law relativeto the NWL Ultra Classic® Annuity. For an explana-tion of how those laws apply to you, we suggest youconsult with your attorney, accountant, or other taxadvisor.

NWL Ultra Classic® AnnuityThe NWL Ultra Classic® Annuity is underwritten byNational Western Life Insurance Company®, Austin,Texas and issued under Policy Form 01-1135-04. NWL Ultra Classic® Annuity is not available in allstates. Certain other limitations and exclusionsmay apply.

Standard and Poor’s®

The S&P 500® Composite Stock Price Index (S&P500® Index) is a market valued-weighted index of 500common stocks traded on every major U.S. StockExchange. These 500 companies tend to be leadingcompanies from leading industries. Often used as abenchmark for economic growth, the S&P 500® iscompiled daily by Standard & Poor’s®, a division of theMcGraw-Hill Companies.

“Standard & Poor’s®”, “S&P®”, “S&P 500®”, Standard& Poor’s 500”, and “500” are trademarks of TheMcGraw-Hill Companies, Inc. and have been licensedfor use by National Western Life Insurance Company®.The NWL Ultra Classic® Annuity is not sponsored,endorsed, sold, or promoted by Standard & Poor’s®,and Standard & Poor’s® makes no representationregarding the advisability of purchasing this product.

Annuity Date, the Beneficiary will receive any unpaidguaranteed amounts as provided by the IncomeSettlement Option in force on the date of death. Thedeath benefit paid to the Beneficiary (except for theestate) may pass without the costs and delays of probate.

What Other Benefits or Features of thisAnnuity Should I Know About? Accidental Death BenefitThis benefit is paid in addition to the regular deathbenefit. The Accidental Death Benefit will be paid tothe Beneficiary if the Annuitant dies from accidentalbodily injury within the terms of the Policy. Theamount of the Accidental Death Benefit is equal to thetotal premiums paid, less withdrawals, as of the date ofthe accidental death. This benefit expires when theAnnuitant’s age is 75. The maximum accidental deathbenefit payable will be $250,000. See Policy for complete details and requirements.

“Free Look” PeriodYour satisfaction is important to us! If you changeyour mind about whether this annuity fits your needsafter you receive your annuity Policy or if you are dissatisfied for any reason, you have at least twentydays* after receipt of the annuity Policy duringwhich you can return it without incurring charges(referred to as a “free look” period). *This time period may be longer; please see your Policyfor details.

100% of the premium is credited to the AccountValue. If applicable, each premium or SettlementOption value will be reduced by the amount ofpremium taxes, fees, or legal assessments imposedby the state or government jurisdiction where youpurchase this annuity. Please remember that with-drawal charges may apply for early withdrawals.

Available Withdrawal Benefit RidersDepending on the state, there may be up to 2 differentWithdrawal Benefit Riders available that offer differentbenefits and have different charges. Income Outlook has a basic set of lifetime income benefits and has annualcharges that are applied only if interest credited to thePolicy to which it is attached can cover them. IncomeOutlook Plus 5 also provides for lifetime income benefitsand includes a bonus, but the charges are applied annually regardless of the amount, if any, of interest credited to the Policy to which it is attached. Please referto the separate consumer disclosure brochure for theappropriate rider elected for a more complete description

DM-1109-SIG.Rev.7.12DM-1109-SIG.Rev.7.12


NWL ULTRA CLASSIC® ANNUITY


NWL ULTRA CLASSIC® ANNUITY

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Consumer Disclosure Brochure Signatures

Thank you for choosing to purchase the NWL Ultra Classic® FlexiblePremium Deferred Equity Indexed Annuity. If you have any questionsafter you receive your annuity Policy, please contact your agent or callNational Western’s Customer Service Department at 1-800-922-9422. We want to be sure that you read all 10 pages of this disclosurebrochure and are aware of the benefits and features explained herein. Please initial and sign where indicated with an asterisk (*),acknowledging that you understand the following:

• This is a deferred annuity, and it is a long-term savings vehicle.

• This annuity has a “free look” period, during which you can surrender the annuity Policy after receiving it without incurringsurrender charges (described more fully in your annuity Policy).

• Any results shown, other than guaranteed minimum values, arenot guarantees, promises, or warranties.

• Withdrawal charges may be deducted from your Account Value.

• If applied for, the annual charge for a Withdrawal Benefit Rider may be deducted from your Account Value.

• Your agent receives compensation for the sale of this annuity Policy.

• The Interest Credit Option B fixed interest rate will likely behigher in the first Policy Year than in subsequent Policy Years.

• The Participation Rates will likely be higher in the first PolicyYear than in subsequent Policy Years and may be as low as 50%,and Asset Fee Rates will likely be lower in the first Policy Yearthan in subsequent Policy Years and may be as high as 6%.

• Renewal Monthly Cap Rate may be as low as 1.00%.

• You can allocate 100% to Option A, B, or D.You can allocate in any combination among Option A, B, or D(must be whole numbers whose sum is 100%).State your allocation percentage here.

_____ % Option A _____ % Option B _____ % Option D

Option A and D may not be available on renewal.

_____ The above-stated features have been fully explained to me.

I have received a copy of this disclosure brochure, and I have reviewedit with my agent. I fully understand the disclosure brochure and thespecific points outlined above. The disclosure brochure is not a partof the annuity Policy and does not modify it in any way. The annu-ity Policy itself contains all terms, benefits, guarantees, limitations,restrictions, and exclusions.

____________________________ _____________ *Applicant’s Signature Date

I certify that I reviewed this disclosure brochure with the applicant.

____________________________ _____________ Agent’s Signature & Agent No. Date

Applicant to Retain

(*Initial)

Consumer Disclosure Brochure Signatures

Thank you for choosing to purchase the NWL Ultra Classic® FlexiblePremium Deferred Equity Indexed Annuity. If you have any questionsafter you receive your annuity Policy, please contact your agent or callNational Western’s Customer Service Department at 1-800-922-9422. We want to be sure that you read all 10 pages of this disclosurebrochure and are aware of the benefits and features explained herein. Please initial and sign where indicated with an asterisk (*),acknowledging that you understand the following:

• This is a deferred annuity, and it is a long-term savings vehicle.

• This annuity has a “free look” period, during which you can surrender the annuity Policy after receiving it without incurringsurrender charges (described more fully in your annuity Policy).

• Any results shown, other than guaranteed minimum values, arenot guarantees, promises, or warranties.

• Withdrawal charges may be deducted from your Account Value.

• If applied for, the annual charge for a Withdrawal Benefit Rider may be deducted from your Account Value.

• Your agent receives compensation for the sale of this annuity Policy.

• The Interest Credit Option B fixed interest rate will likely behigher in the first Policy Year than in subsequent Policy Years.

• The Participation Rates will likely be higher in the first PolicyYear than in subsequent Policy Years and may be as low as 50%,and Asset Fee Rates will likely be lower in the first Policy Yearthan in subsequent Policy Years and may be as high as 6%.

• Renewal Monthly Cap Rate may be as low as 1.00%.

• You can allocate 100% to Option A, B, or D.You can allocate in any combination among Option A, B, or D(must be whole numbers whose sum is 100%).State your allocation percentage here.

_____ % Option A _____ % Option B _____ % Option D

Option A and D may not be available on renewal.

_____ The above-stated features have been fully explained to me.

I have received a copy of this disclosure brochure, and I have reviewedit with my agent. I fully understand the disclosure brochure and thespecific points outlined above. The disclosure brochure is not a partof the annuity Policy and does not modify it in any way. The annu-ity Policy itself contains all terms, benefits, guarantees, limitations,restrictions, and exclusions.

____________________________ _____________ *Applicant’s Signature Date

I certify that I reviewed this disclosure brochure with the applicant.

____________________________ _____________ Agent’s Signature & Agent No. Date


(*Initial)

National Western Life Insurance Company® • 850 East Anderson Lane • Austin, Texas 78752


Still A Sure WIN to Provide Security For Your Withdrawal Income Needs!Optional Benefit Available on Indexed Annuities

DM-1120.Rev.1.13

CLIENT SERVICES TOLL-FREE 800-922-9422 • FAX 512-339-8350www.nationalwesternlife.com



Income Outlook Plus 5 - Withdrawal Benefit RiderThank you for choosing to add Income Outlook Plus 5 to your National Western Life indexed annuity. If you have any ques-tions, please contact your agent or call National Western’s Customer Service Department at 1-800-922-9422.

We want to be sure that you read all 12 pages of this brochure and are aware of the benefits and features ex-plained herein. Please initial and sign where indicated with an asterisk (*), acknowledging that you understand the following:

• This is a withdrawal benefit rider that guarantees lifetime Withdrawal Payments after age 60.

• For purposes of this brochure, the assumption is that the Annuitant and Owner are the same.

• OncetheWithdrawalPaymentsbegin,thereisnofurtherAccumulation Period available.

• The full benefits of this rider are not obtained if the Withdrawal Payments are never taken.

• TheAccountValueofthepolicyisreducedeachyearbytheAnnual Rider Charge shown on page 1 of the rider, regardless of whether Withdrawal Payments are taken.

• Ifat the end of Accumulation Period you have not yet requested Withdrawal Payments or elected the Restart option, the Annual Rider Charge will continue to be deducted from the Account Value and the Accumulation Period Withdrawal Payment Base will no longer accumulate with interest.

• Any election to start or stop Withdrawal Payments must be received at National Western Life Insurance Company at least 20 days prior to the Policy Anniversary.


I have received a copy of this brochure, and I have reviewed it with my agent. I fully understand the brochure and the specific points outlined above. The brochure is not a part of the rider and does not modify it in any way. The rider itself contains all terms, benefits, guarantees, limitations, re-strictions, and exclusions.

______________________________________*Applicant’s Signature Date


______________________________________Agent’s Signature & Agent No. Date



















NWL®’s Income Outlook Plus 5 provides:

•GreatgrowthpotentialforyourlifetimeWithdrawalPayments…•ControlofwhenyourWithdrawalPaymentsbegin…•GuaranteedWithdrawalPercentagesthatincreaseatselectedages…•AccesstoyourmoneyforAdditionalWithdrawalsremains…

•GuaranteedWithdrawalPaymentsforlifeanytimeaftertheageof60!

Adding Income Outlook Plus 5 to your National Western Life indexed annuity at purchase will give you all of these benefits. This withdrawal benefit rider works with all of your annuity’s traditional benefits and enhances the benefits with guaranteed Withdrawal Payments you cannot outlive.

INCOMEOUTLOOKPLUS5HIGHLIGHTSIncome Outlook Plus 5 guarantees during the Accumulation Period:

•4% interest on the Accumulation Period Withdrawal Payment Base until lifetime WithdrawalPayments begin

•5% Rider Bonus on the premiums received in the first Policy Year subject to the Rider Bonus VestingSchedule

•TheGuaranteedWithdrawalPercentagesincreaseateveryfifthageuntilage90oruntilthelifetimeWithdrawal Payments begin

•Accesstotheannuity’sAccountValueremains

•TheoptiontoRestart the ten year Accumulation Period at the end of the fifth Policy Year

Income Outlook Plus 5 guarantees during the Withdrawal Period:

•WithdrawalPaymentsthatcanbepaidforlife

•Theabilitytostop and start Withdrawal Payments

•NowithdrawalchargesonWithdrawalPaymentstakenunderthisrider

•TheWithdrawalPaymentBasetoStep-Uptotheannuity’sAccountValue*iflarger,whenthe Withdrawal Period begins and each Policy Anniversary thereafter

•TheMaximumGuaranteedAnnualWithdrawalPaymentincreaseseachtimethereisaStep-Upinthe Withdrawal Payment Base


•RequiredMinimumDistributionfriendly

*IfthebaseannuitypolicyhasapremiumbonusthatisnotincludedintheAccountValue,thenforpurposesofRestart,Step-Up,and

Withdrawal Payment Base, theAccountValuewillbeincreasedbyanyapplicablebaseannuityVestedBonusValue.

INCOME OUTLOOK PLUS 5

NWL®’sNextGenerationBenefitRiderEnjoy the benefits of guaranteed lifetime retirement income with enhanced accumulations and control of your annuity!National Western Life requires that the Agent review this entire brochure with you.

INCOME OUTLOOK PLUS 5 DETAILSIncome Outlook Plus 5 is available to add as a rider to your National Western Life indexed annuity only at the time of purchase.

The Withdrawal Payment is the amount you choose to receive each year. The Maximum GuaranteedAnnualWithdrawalPaymentisguaranteed to be paid for your lifetime if no Additional Withdrawals are taken. Your age must be at least 60 before Withdrawal Payments may begin. You may begin taking Withdrawal Payments as early as the first Policy Anniversary or any Policy Anniversary you choose after that. The Withdrawal Payments taken under this rider are deducted from the annuity’s Account Valueandwillnotincuranywithdrawalcharges.

There is an Annual Rider Charge for this benefit on each Policy Anniversary, beginning with the first. The Annual Rider Charge Rate is determined on the Policy Date and is shown on page 1 of the rider. This rate is guaranteed not to change while this rider is in force unless Restart (as described below) is elected and will never exceed the maximum rate of 1.5%.

There is a Rider Bonus added to the Accumulation Period Withdrawal Payment Base. The Rider Bonus is the Rider Bonus Rate shown on Page 1 of the rider multiplied by the premium received during the first Policy Year. The Rider Bonus is credited with interest at the same rate as the Account Value of the Policy. The Rider Bonus is available on a pro-rata basis based on the Rider Bonus Vesting Schedule shown on Page 1 of the rider and described on page 6 of this disclosure for Additional Withdrawals, full surrender, or annuitization of the Policy. This means the Rider Bonus will not be available in all Policy Years, as described more fully on page 6 of this disclosure. The Rider Bonus is fully included in the Account Value for purposes of the Death Benefit.

CancellationYou may cancel this rider at anytime. The rider will terminate when the annuity terminates for anyreasonorwhentheMaximumGuaranteedAnnual Withdrawal Payment is less than $100.

CONCLUSION

Income Outlook Plus 5 from National Western Life provides the security of a guaranteed income stream you can not outlive in retirement. This rider also offers the opportunity for larger income benefits when indexed interest credits increase your annuity’s AccountValue.Italsogivesyoucontrolofyourannuity as your needs change and access to your money if needed.

About the CompanyNational Western Life Insurance Company® is a Colorado corporation with executive offices in Austin, Texas. The Company offers a full line of life insurance and annuity products (both on an individual and group basis), through independent agency offices in 49 states and the District of Columbia, and accepts applications fromresidentsofseveralforeigncountries.Visitour website at www.nationalwesternlife.com for all current financial information.


Page 3Page 10

The Income Outlook Plus 5 rider has two periods, the Accumulation Period and the Withdrawal Period. Each period is described as follows.

During the Accumulation PeriodThe Accumulation Period Withdrawal Payment Base has a 4% interest rate that is guaranteed each year during the Accumulation Period. The Accumulation Period Withdrawal Payment Base initially equals the premium paid, plus any applicable premium bonus. Additional premiums paid and premium bonuses, if applicable, will be added to the Accumulation Period Withdrawal Payment Base when they are received. Withdrawals madefromtheAccountValuewillreducetheAccumulation Period Withdrawal Payment Base.



•The4%guaranteedinterestrateontheAccumulation Period Withdrawal Payment Base will be guaranteed from Restart;

•TheAccumulationPeriodWithdrawalPaymentBase will be increased to the annuity’s Account Value*,iflarger;and

•TheAnnualRiderChargeRatemaychange,butwillnot be higher than the maximum guaranteed charge of 1.5%. You must wait five years after each Restart before beginning a new Accumulation Period.

*If the base annuity policy has a premium bonus that is not included intheAccountValue,thenforpurposesofRestart,Step-Up,andWithdrawalPaymentBase,theAccountValuewillbeincreasedbyanyapplicablebaseannuityVestedBonusValue.

Withdrawals Withdrawals may be made at anytime as provided by the annuity. Withdrawals from your annuity will reduce the Accumulation Period Withdrawal Payment Base by the same percentage reduction madetotheannuity’sAccountValue.

Issue Age


1 2 3 4 5 6 7 8 9 10

60 5,460 5,678 5,906 6,142 7,026 7,307 7,600 7,903 8,220 9,326 61 5,460 5,678 5,906 6,756 7,026 7,307 7,600 7,903 8,967 9,326 62 5,460 5,678 6,496 6,756 7,026 7,307 7,600 8,622 8,967 9,326 63 5,460 6,246 6,496 6,756 7,026 7,307 8,290 8,622 8,967 9,326 64 6,006 6,246 6,496 6,756 7,026 7,972 8,290 8,622 8,967 9,326 65 6,006 6,246 6,496 6,756 7,665 7,972 8,290 8,622 8,967 10,103 66 6,006 6,246 6,496 7,370 7,665 7,972 8,290 8,622 9,714 10,103 67 6,006 6,246 7,087 7,370 7,665 7,972 8,290 9,340 9,714 10,103 68 6,006 6,814 7,087 7,370 7,665 7,972 8,981 9,340 9,714 10,103 69 6,552 6,814 7,087 7,370 7,665 8,636 8,981 9,340 9,714 10,103 70 6,552 6,814 7,087 7,370 8,304 8,636 8,981 9,340 9,714 10,880 71 6,552 6,814 7,087 7,984 8,304 8,636 8,981 9,340 10,461 10,880 72 6,552 6,814 7,677 7,984 8,304 8,636 8,981 10,059 10,461 10,880 73 6,552 7,382 7,677 7,984 8,304 8,636 9,672 10,059 10,461 10,880 74 7,098 7,382 7,677 7,984 8,304 9,300 9,672 10,059 10,461 10,880 75 7,098 7,382 7,677 7,984 8,942 9,300 9,672 10,059 10,461 11,657 76 7,098 7,382 7,677 8,598 8,942 9,300 9,672 10,059 11,209 11,657 77 7,098 7,382 8,268 8,598 8,942 9,300 9,672 10,777 11,209 11,657 78 7,098 7,950 8,268 8,598 8,942 9,300 10,363 10,777 11,209 11,657 79 7,644 7,950 8,268 8,598 8,942 9,964 10,363 10,777 11,209 11,657 80 7,644 7,950 8,268 8,598 9,581 9,964 10,363 10,777 11,209 12,434 81 7,644 7,950 8,268 9,213 9,581 9,964 10,363 10,777 11,956 12,434 82 7,644 7,950 8,858 9,213 9,581 9,964 10,363 11,496 11,956 12,434 83 7,644 8,518 8,858 9,213 9,581 9,964 11,054 11,496 11,956 12,434 84 8,190 8,518 8,858 9,213 9,581 10,629 11,054 11,496 11,956 12,434 85 8,190 8,518 8,858 9,213 10,220 10,629 11,054 11,496 11,956 12,434

$100,000 Premium – Maximum Guaranteed Annual Withdrawal Payments - Single Annuitant

Page 4 Page 9

This is a hypothetical example that illustrates values for a single annuitant. This example does not demonstrate an actual crediting scenario and is not a projection of the future results.

Example:A$20,000withdrawalismade.TheAccountValueis$250,000beforethewithdrawal.AfterthewithdrawaltheAccountValueis$230,000,or92%oftheAccountValuebeforethewithdrawal.TheAccumulation Period Withdrawal Payment Base is $240,000 before the withdrawal. It is multiplied by 92% and equals $220,800 after the Withdrawal.


During the Withdrawal PeriodThe Withdrawal Payment amount you choose to receive is guaranteed to be paid for your lifetime if it doesnotexceedtheMaximumGuaranteedAnnualWithdrawalPayment.TheMaximumGuaranteedAnnual Withdrawal Payment will remain level unless there is a Step-Up in the Withdrawal Payment Base, or you take an Additional Withdrawal.

You may receive your Withdrawal Payment annually, semi-annually, quarterly, or monthly. Each payment must be at least $100. Any election to start or stop Withdrawal Payments must be received at National Western Life Insurance Company® at least 20 days prior to the Policy Anniversary.

When the Withdrawal Period begins:

• TheGuaranteedWithdrawalPercentageisdetermined;• TheWithdrawalPaymentBaseisincreasedtotheannuity’sAccountValue*ifitislarger;• TheMaximumGuaranteedAnnualWithdrawalPaymentiscalculated;• Anyoutstandingloanmustberepaid;• NomoreloansorSystematicWithdrawalsofInterestfromtheAccountValueofthePolicymay

be taken; and• Anyapplicablepenalty-freewithdrawalamountthatisavailableeachPolicyYearunderthebase annuity policy will be reduced by the Withdrawal Payment.




The Maximum Guaranteed Annual Withdrawal Payment equals the Withdrawal Payment Base multipliedbytheGuaranteedWithdrawalPercentage.

Example: Five years ago, you purchased an annuity with Income Outlook Plus 5 with $100,000 and have now decided to begin Withdrawal Payments. The Withdrawal Payment Base is now $121,665 afterfiveyearsof4%interestandyourGuaranteedWithdrawalPercentageis6.5%.Atthistime,yourMaximumGuaranteedAnnualWithdrawalPaymentis$7,908andyourannuity’sAccountValueis$131,317.Therefore,theWithdrawalPaymentBaseisincreasedtotheAccountValueandyourMaximumGuaranteedAnnualWithdrawalPaymentis$8,536.

$250,000- 20,000

$230,000

230,000 ÷ 250,000 = 92% $240,000x .92

$220,800


Account Value

ThetablebelowhastheGuaranteedWithdrawal Percentages when there are joint annuitants. The percentage is based on the age of the younger annuitant on the Policy Anniversary that you begin Withdrawal Payments.

Age Percentage

60-64 4.00%65-69 4.50%70-74 5.00%75-79 5.50%80-84 6.00%85-89 6.50%90+ 7.00%

Page 5Page 8

ADDITIONAL DETAILS

Issue AgesIncome Outlook Plus 5 may be added to the annuity only at the time of purchase, regardless of age.


AnnuitantsThe Annuitant and Joint Annuitant, if any, cannot be changed after the annuity is issued.


Guaranteed Withdrawal PercentagesTheGuaranteedWithdrawalPercentageisbasedon your age on the Policy Anniversary that you begin Withdrawal Payments.

ThetablebelowhastheGuaranteedWithdrawalPercentages for a single annuitant.

Age Percentage60-64 5.00%65-69 5.50%70-74 6.00%75-79 6.50%80-84 7.00%85-89 7.50%90+ 8.00%




Policy Years

Annuitants Age

Withdrawal Payment

Base


MGAWPWithdrawal

Payment Base


MGAWPWithdrawal

Payment Base


MGAWP

0 65 105,000 105,000 105,000 1 66 109,200 5.50% 6,006 109,200 109,200 2 67 109,200 5.50% 6,006 113,568 113,568 3 68 109,200 5.50% 6,006 118,111 118,111 4 69 109,200 5.50% 6,006 122,835 122,835 5 70 109,200 5.50% 6,006 127,749 6.00% 7,665 127,749 6 71 109,200 5.50% 6,006 127,749 6.00% 7,665 132,858 7 72 109,200 5.50% 6,006 127,749 6.00% 7,665 138,173 8 73 109,200 5.50% 6,006 127,749 6.00% 7,665 143,700 9 74 109,200 5.50% 6,006 127,749 6.00% 7,665 149,448

10 75 109,200 5.50% 6,006 127,749 6.00% 7,665 155,426 6.50% 10,103 11 76 109,200 5.50% 6,006 127,749 6.00% 7,665 155,426 6.50% 10,103 12 77 109,200 5.50% 6,006 127,749 6.00% 7,665 155,426 6.50% 10,103 13 78 109,200 5.50% 6,006 127,749 6.00% 7,665 155,426 6.50% 10,103 14 79 109,200 5.50% 6,006 127,749 6.00% 7,665 155,426 6.50% 10,103 15 80 109,200 5.50% 6,006 127,749 6.00% 7,665 155,426 6.50% 10,103


Page 6 Page 7

Step-UpOn each Policy Anniversary during the Withdrawal Period, the Withdrawal Payment Base will be comparedtotheannuity’sAccountValue*.IftheAccountValue*islargerthantheWithdrawalPaymentBase,theWithdrawalPaymentBasewillStep-UptotheAccountValue*.

FollowingtheStep-Up,theMaximumGuaranteedAnnualWithdrawalPaymentisrecalculatedandincreased, based on this higher Withdrawal Payment Base. These payments are guaranteed for your lifetime.

Example:AttheendoftwoyearsofWithdrawalPayments,yourannuity’sAccountValuehasgrownto$132,725.YourWithdrawalPaymentBaseof$131,317willStep-Upto$132,725.TheMaximumGuaranteedAnnualWithdrawalPaymentwillbeincreasedto$8,627,whichequalstheWithdrawalPaymentBaseof$132,725multipliedbytheGuaranteedWithdrawalPercentageof6.5%.

*IfthebaseannuitypolicyhasapremiumbonusthatisnotincludedintheAccountValue,thenforpurposesofRestart,Step-Up,andWithdrawal Payment Base, theAccountValuewillbeincreasedbyanyapplicablebaseannuityVestedBonusValue.

Additional WithdrawalsAn Additional Withdrawal is any withdrawal that is not a Withdrawal Payment and may be made at anytime during the Withdrawal Period. Additional Withdrawals reduce the Withdrawal Payment Base and Withdrawal Payments using the pro-rata adjustment factor. The pro-rata adjustment factor is based onthechangeinAccountValueduetotheAdditionalWithdrawal.

TheMaximumGuaranteedAnnualWithdrawalPaymentwillchangetoequaltheGuaranteedWithdrawal Percentage multiplied by the Withdrawal Payment Base after the Additional Withdrawal. ThenewMaximumGuaranteedAnnualWithdrawalPaymentwillbecome effective on the Policy Anniversary following the Additional Withdrawal.

Rider Bonus Vesting ScheduleFor purposes of Additional Withdrawals, full surrenders, or annuitization, the Rider Bonus is available onapro-ratabasisbasedontheRiderBonusVestingScheduleshownonPage1oftheRideranddetailedbelow: RiderBonusVestingSchedule

PolicyYears1-7 [0%] PolicyYear8 [25%] PolicyYear9 [50%] PolicyYear10andlater [100%]

Therefore,inaccordancewiththeRiderBonusVestingScheduleabove,ifyoutakeanyAdditionalWithdrawals, fully surrender, or annuitize pursuant to the terms of the Policy/Contract to which this riderisattached,noportionoftheRiderBonuswillbeavailabletoyouinyears1-7,andonlyalimitedportion will be available in years 8 and 9.

Beginning in Policy Year 10, the full Rider Bonus will be available.

Required Minimum Distributions (RMDs)IftheRMDpaymentisgreaterthantheMaximumGuaranteedAnnualWithdrawalPayment,theadditional amount withdrawn to meet the RMD payment will not be considered an Additional Withdrawal.




Policy Years

Annuitants Age

Withdrawal Payment

Base


MGAWPWithdrawal

Payment Base


MGAWPWithdrawal

Payment Base


MGAWP

0 65 105,000 105,000 105,000 1 66 109,200 5.50% 6,006 109,200 109,200 2 67 109,200 5.50% 6,006 113,568 113,568 3 68 109,200 5.50% 6,006 118,111 118,111 4 69 109,200 5.50% 6,006 122,835 122,835 5 70 109,200 5.50% 6,006 127,749 6.00% 7,665 127,749 6 71 109,200 5.50% 6,006 127,749 6.00% 7,665 132,858 7 72 109,200 5.50% 6,006 127,749 6.00% 7,665 138,173 8 73 109,200 5.50% 6,006 127,749 6.00% 7,665 143,700 9 74 109,200 5.50% 6,006 127,749 6.00% 7,665 149,448

10 75 109,200 5.50% 6,006 127,749 6.00% 7,665 155,426 6.50% 10,103 11 76 109,200 5.50% 6,006 127,749 6.00% 7,665 155,426 6.50% 10,103 12 77 109,200 5.50% 6,006 127,749 6.00% 7,665 155,426 6.50% 10,103 13 78 109,200 5.50% 6,006 127,749 6.00% 7,665 155,426 6.50% 10,103 14 79 109,200 5.50% 6,006 127,749 6.00% 7,665 155,426 6.50% 10,103 15 80 109,200 5.50% 6,006 127,749 6.00% 7,665 155,426 6.50% 10,103


Page 6 Page 7

Step-UpOn each Policy Anniversary during the Withdrawal Period, the Withdrawal Payment Base will be comparedtotheannuity’sAccountValue*.IftheAccountValue*islargerthantheWithdrawalPaymentBase,theWithdrawalPaymentBasewillStep-UptotheAccountValue*.

FollowingtheStep-Up,theMaximumGuaranteedAnnualWithdrawalPaymentisrecalculatedandincreased, based on this higher Withdrawal Payment Base. These payments are guaranteed for your lifetime.

Example:AttheendoftwoyearsofWithdrawalPayments,yourannuity’sAccountValuehasgrownto$132,725.YourWithdrawalPaymentBaseof$131,317willStep-Upto$132,725.TheMaximumGuaranteedAnnualWithdrawalPaymentwillbeincreasedto$8,627,whichequalstheWithdrawalPaymentBaseof$132,725multipliedbytheGuaranteedWithdrawalPercentageof6.5%.

*IfthebaseannuitypolicyhasapremiumbonusthatisnotincludedintheAccountValue,thenforpurposesofRestart,Step-Up,andWithdrawal Payment Base, theAccountValuewillbeincreasedbyanyapplicablebaseannuityVestedBonusValue.

Additional WithdrawalsAn Additional Withdrawal is any withdrawal that is not a Withdrawal Payment and may be made at anytime during the Withdrawal Period. Additional Withdrawals reduce the Withdrawal Payment Base and Withdrawal Payments using the pro-rata adjustment factor. The pro-rata adjustment factor is based onthechangeinAccountValueduetotheAdditionalWithdrawal.

TheMaximumGuaranteedAnnualWithdrawalPaymentwillchangetoequaltheGuaranteedWithdrawal Percentage multiplied by the Withdrawal Payment Base after the Additional Withdrawal. ThenewMaximumGuaranteedAnnualWithdrawalPaymentwillbecome effective on the Policy Anniversary following the Additional Withdrawal.

Rider Bonus Vesting ScheduleFor purposes of Additional Withdrawals, full surrenders, or annuitization, the Rider Bonus is available onapro-ratabasisbasedontheRiderBonusVestingScheduleshownonPage1oftheRideranddetailedbelow: RiderBonusVestingSchedule

PolicyYears1-7 [0%] PolicyYear8 [25%] PolicyYear9 [50%] PolicyYear10andlater [100%]

Therefore,inaccordancewiththeRiderBonusVestingScheduleabove,ifyoutakeanyAdditionalWithdrawals, fully surrender, or annuitize pursuant to the terms of the Policy/Contract to which this riderisattached,noportionoftheRiderBonuswillbeavailabletoyouinyears1-7,andonlyalimitedportion will be available in years 8 and 9.

Beginning in Policy Year 10, the full Rider Bonus will be available.

Required Minimum Distributions (RMDs)IftheRMDpaymentisgreaterthantheMaximumGuaranteedAnnualWithdrawalPayment,theadditional amount withdrawn to meet the RMD payment will not be considered an Additional Withdrawal.

Example:A$20,000withdrawalismade.TheAccountValueis$250,000beforethewithdrawal.AfterthewithdrawaltheAccountValueis$230,000,or92%oftheAccountValuebeforethewithdrawal.TheAccumulation Period Withdrawal Payment Base is $240,000 before the withdrawal. It is multiplied by 92% and equals $220,800 after the Withdrawal.


During the Withdrawal PeriodThe Withdrawal Payment amount you choose to receive is guaranteed to be paid for your lifetime if it doesnotexceedtheMaximumGuaranteedAnnualWithdrawalPayment.TheMaximumGuaranteedAnnual Withdrawal Payment will remain level unless there is a Step-Up in the Withdrawal Payment Base, or you take an Additional Withdrawal.

You may receive your Withdrawal Payment annually, semi-annually, quarterly, or monthly. Each payment must be at least $100. Any election to start or stop Withdrawal Payments must be received at National Western Life Insurance Company® at least 20 days prior to the Policy Anniversary.

When the Withdrawal Period begins:

• TheGuaranteedWithdrawalPercentageisdetermined;• TheWithdrawalPaymentBaseisincreasedtotheannuity’sAccountValue*ifitislarger;• TheMaximumGuaranteedAnnualWithdrawalPaymentiscalculated;• Anyoutstandingloanmustberepaid;• NomoreloansorSystematicWithdrawalsofInterestfromtheAccountValueofthePolicymay

be taken; and• Anyapplicablepenalty-freewithdrawalamountthatisavailableeachPolicyYearunderthebase annuity policy will be reduced by the Withdrawal Payment.




The Maximum Guaranteed Annual Withdrawal Payment equals the Withdrawal Payment Base multipliedbytheGuaranteedWithdrawalPercentage.

Example: Five years ago, you purchased an annuity with Income Outlook Plus 5 with $100,000 and have now decided to begin Withdrawal Payments. The Withdrawal Payment Base is now $121,665 afterfiveyearsof4%interestandyourGuaranteedWithdrawalPercentageis6.5%.Atthistime,yourMaximumGuaranteedAnnualWithdrawalPaymentis$7,908andyourannuity’sAccountValueis$131,317.Therefore,theWithdrawalPaymentBaseisincreasedtotheAccountValueandyourMaximumGuaranteedAnnualWithdrawalPaymentis$8,536.

$250,000- 20,000

$230,000

230,000 ÷ 250,000 = 92% $240,000x .92

$220,800


Account Value

ThetablebelowhastheGuaranteedWithdrawal Percentages when there are joint annuitants. The percentage is based on the age of the younger annuitant on the Policy Anniversary that you begin Withdrawal Payments.

Age Percentage

60-64 4.00%65-69 4.50%70-74 5.00%75-79 5.50%80-84 6.00%85-89 6.50%90+ 7.00%

Page 5Page 8

ADDITIONAL DETAILS

Issue AgesIncome Outlook Plus 5 may be added to the annuity only at the time of purchase, regardless of age.


AnnuitantsThe Annuitant and Joint Annuitant, if any, cannot be changed after the annuity is issued.


Guaranteed Withdrawal PercentagesTheGuaranteedWithdrawalPercentageisbasedon your age on the Policy Anniversary that you begin Withdrawal Payments.

ThetablebelowhastheGuaranteedWithdrawalPercentages for a single annuitant.

Age Percentage60-64 5.00%65-69 5.50%70-74 6.00%75-79 6.50%80-84 7.00%85-89 7.50%90+ 8.00%

The Income Outlook Plus 5 rider has two periods, the Accumulation Period and the Withdrawal Period. Each period is described as follows.

During the Accumulation PeriodThe Accumulation Period Withdrawal Payment Base has a 4% interest rate that is guaranteed each year during the Accumulation Period. The Accumulation Period Withdrawal Payment Base initially equals the premium paid, plus any applicable premium bonus. Additional premiums paid and premium bonuses, if applicable, will be added to the Accumulation Period Withdrawal Payment Base when they are received. Withdrawals madefromtheAccountValuewillreducetheAccumulation Period Withdrawal Payment Base.



•The4%guaranteedinterestrateontheAccumulation Period Withdrawal Payment Base will be guaranteed from Restart;

•TheAccumulationPeriodWithdrawalPaymentBase will be increased to the annuity’s Account Value*,iflarger;and

•TheAnnualRiderChargeRatemaychange,butwillnot be higher than the maximum guaranteed charge of 1.5%. You must wait five years after each Restart before beginning a new Accumulation Period.

*If the base annuity policy has a premium bonus that is not included intheAccountValue,thenforpurposesofRestart,Step-Up,andWithdrawalPaymentBase,theAccountValuewillbeincreasedbyanyapplicablebaseannuityVestedBonusValue.

Withdrawals Withdrawals may be made at anytime as provided by the annuity. Withdrawals from your annuity will reduce the Accumulation Period Withdrawal Payment Base by the same percentage reduction madetotheannuity’sAccountValue.

Issue Age


1 2 3 4 5 6 7 8 9 10

60 5,460 5,678 5,906 6,142 7,026 7,307 7,600 7,903 8,220 9,326 61 5,460 5,678 5,906 6,756 7,026 7,307 7,600 7,903 8,967 9,326 62 5,460 5,678 6,496 6,756 7,026 7,307 7,600 8,622 8,967 9,326 63 5,460 6,246 6,496 6,756 7,026 7,307 8,290 8,622 8,967 9,326 64 6,006 6,246 6,496 6,756 7,026 7,972 8,290 8,622 8,967 9,326 65 6,006 6,246 6,496 6,756 7,665 7,972 8,290 8,622 8,967 10,103 66 6,006 6,246 6,496 7,370 7,665 7,972 8,290 8,622 9,714 10,103 67 6,006 6,246 7,087 7,370 7,665 7,972 8,290 9,340 9,714 10,103 68 6,006 6,814 7,087 7,370 7,665 7,972 8,981 9,340 9,714 10,103 69 6,552 6,814 7,087 7,370 7,665 8,636 8,981 9,340 9,714 10,103 70 6,552 6,814 7,087 7,370 8,304 8,636 8,981 9,340 9,714 10,880 71 6,552 6,814 7,087 7,984 8,304 8,636 8,981 9,340 10,461 10,880 72 6,552 6,814 7,677 7,984 8,304 8,636 8,981 10,059 10,461 10,880 73 6,552 7,382 7,677 7,984 8,304 8,636 9,672 10,059 10,461 10,880 74 7,098 7,382 7,677 7,984 8,304 9,300 9,672 10,059 10,461 10,880 75 7,098 7,382 7,677 7,984 8,942 9,300 9,672 10,059 10,461 11,657 76 7,098 7,382 7,677 8,598 8,942 9,300 9,672 10,059 11,209 11,657 77 7,098 7,382 8,268 8,598 8,942 9,300 9,672 10,777 11,209 11,657 78 7,098 7,950 8,268 8,598 8,942 9,300 10,363 10,777 11,209 11,657 79 7,644 7,950 8,268 8,598 8,942 9,964 10,363 10,777 11,209 11,657 80 7,644 7,950 8,268 8,598 9,581 9,964 10,363 10,777 11,209 12,434 81 7,644 7,950 8,268 9,213 9,581 9,964 10,363 10,777 11,956 12,434 82 7,644 7,950 8,858 9,213 9,581 9,964 10,363 11,496 11,956 12,434 83 7,644 8,518 8,858 9,213 9,581 9,964 11,054 11,496 11,956 12,434 84 8,190 8,518 8,858 9,213 9,581 10,629 11,054 11,496 11,956 12,434 85 8,190 8,518 8,858 9,213 10,220 10,629 11,054 11,496 11,956 12,434

$100,000 Premium – Maximum Guaranteed Annual Withdrawal Payments - Single Annuitant

Page 4 Page 9


INCOME OUTLOOK PLUS 5 DETAILSIncome Outlook Plus 5 is available to add as a rider to your National Western Life indexed annuity only at the time of purchase.

The Withdrawal Payment is the amount you choose to receive each year. The Maximum GuaranteedAnnualWithdrawalPaymentisguaranteed to be paid for your lifetime if no Additional Withdrawals are taken. Your age must be at least 60 before Withdrawal Payments may begin. You may begin taking Withdrawal Payments as early as the first Policy Anniversary or any Policy Anniversary you choose after that. The Withdrawal Payments taken under this rider are deducted from the annuity’s Account Valueandwillnotincuranywithdrawalcharges.

There is an Annual Rider Charge for this benefit on each Policy Anniversary, beginning with the first. The Annual Rider Charge Rate is determined on the Policy Date and is shown on page 1 of the rider. This rate is guaranteed not to change while this rider is in force unless Restart (as described below) is elected and will never exceed the maximum rate of 1.5%.

There is a Rider Bonus added to the Accumulation Period Withdrawal Payment Base. The Rider Bonus is the Rider Bonus Rate shown on Page 1 of the rider multiplied by the premium received during the first Policy Year. The Rider Bonus is credited with interest at the same rate as the Account Value of the Policy. The Rider Bonus is available on a pro-rata basis based on the Rider Bonus Vesting Schedule shown on Page 1 of the rider and described on page 6 of this disclosure for Additional Withdrawals, full surrender, or annuitization of the Policy. This means the Rider Bonus will not be available in all Policy Years, as described more fully on page 6 of this disclosure. The Rider Bonus is fully included in the Account Value for purposes of the Death Benefit.

CancellationYou may cancel this rider at anytime. The rider will terminate when the annuity terminates for anyreasonorwhentheMaximumGuaranteedAnnual Withdrawal Payment is less than $100.

CONCLUSION

Income Outlook Plus 5 from National Western Life provides the security of a guaranteed income stream you can not outlive in retirement. This rider also offers the opportunity for larger income benefits when indexed interest credits increase your annuity’s AccountValue.Italsogivesyoucontrolofyourannuity as your needs change and access to your money if needed.

About the CompanyNational Western Life Insurance Company® is a Colorado corporation with executive offices in Austin, Texas. The Company offers a full line of life insurance and annuity products (both on an individual and group basis), through independent agency offices in 49 states and the District of Columbia, and accepts applications fromresidentsofseveralforeigncountries.Visitour website at www.nationalwesternlife.com for all current financial information.


Page 3Page 10


































NWL®’s Income Outlook Plus 5 provides:

•GreatgrowthpotentialforyourlifetimeWithdrawalPayments…•ControlofwhenyourWithdrawalPaymentsbegin…•GuaranteedWithdrawalPercentagesthatincreaseatselectedages…•AccesstoyourmoneyforAdditionalWithdrawalsremains…

•GuaranteedWithdrawalPaymentsforlifeanytimeaftertheageof60!

Adding Income Outlook Plus 5 to your National Western Life indexed annuity at purchase will give you all of these benefits. This withdrawal benefit rider works with all of your annuity’s traditional benefits and enhances the benefits with guaranteed Withdrawal Payments you cannot outlive.

INCOMEOUTLOOKPLUS5HIGHLIGHTSIncome Outlook Plus 5 guarantees during the Accumulation Period:

•4% interest on the Accumulation Period Withdrawal Payment Base until lifetime WithdrawalPayments begin

•5% Rider Bonus on the premiums received in the first Policy Year subject to the Rider Bonus VestingSchedule

•TheGuaranteedWithdrawalPercentagesincreaseateveryfifthageuntilage90oruntilthelifetimeWithdrawal Payments begin


•TheoptiontoRestart the ten year Accumulation Period at the end of the fifth Policy Year

Income Outlook Plus 5 guarantees during the Withdrawal Period:

•WithdrawalPaymentsthatcanbepaidforlife

•Theabilitytostop and start Withdrawal Payments

•NowithdrawalchargesonWithdrawalPaymentstakenunderthisrider

•TheWithdrawalPaymentBasetoStep-Uptotheannuity’sAccountValue*iflarger,whenthe Withdrawal Period begins and each Policy Anniversary thereafter

•TheMaximumGuaranteedAnnualWithdrawalPaymentincreaseseachtimethereisaStep-Upinthe Withdrawal Payment Base


•RequiredMinimumDistributionfriendly



INCOME OUTLOOK PLUS 5

NWL®’sNextGenerationBenefitRiderEnjoy the benefits of guaranteed lifetime retirement income with enhanced accumulations and control of your annuity!National Western Life requires that the Agent review this entire brochure with you.

National Western Life Insurance Company® • 850 East Anderson Lane • Austin, Texas 78752


Still A Sure WIN to Provide Security For Your Withdrawal Income Needs!Optional Benefit Available on Indexed Annuities

DM-1120.Rev.1.13



Internal Replacement Form for Life Insurance and Annuities

PLEASE READ CAREFULLY: This information has been prepared for you so that you may make an informed decision on the use of your policy values to fund the purchases of a new policy. CURRENT POLICY INFORMATION Life Annuity

Policyowner’s Name ____________________________ Policy Number______________________________ Current Death Benefit $ ____________________ Current Premium Amount $ __________________________

Cash Surrender Value $ ____________________ Outstanding Indebtedness $ __________________________ Dividend Value __________________________ Dividend Accumulations $ ___________________________

PROPOSED POLICY INFORMATION Life Annuity

Policyowner’s Name ____________________________ Policy Number______________________________ Initial Death Benefit $ _____________________ Proposed Premium Amount $_________________________

Proposed Effective Date _______________ Premium Payable to Age ___________ or for ___________years Outstanding Indebtedness $ ______________ Dividends ________ Dividend Accumulations $ ___________

CURRENT POLICY INFORMATION (after replacement) Life Annuity Does not apply

Policyowner’s Name ____________________________ Policy Number______________________________ Current Death Benefit $ ____________________ Current Premium Amount $ __________________________

Cash Surrender Value $ ____________________ Outstanding Indebtedness $ __________________________ Dividend Value __________________________ Dividend Accumulations $ ___________________________

YOUR CURRENT POLICY COULD TERMINATE

If the policy values of your CURRENT POLICY are used as a source of funding for the purchase of an additional policy, it is estimated that your CURRENT POLICY will not terminate terminate on

______________ (date). It is estimated that you will begin making payments for the PROPOSED POLICY from your own funds on

____________ (date) in the amount of $ _______________ to be paid each ____________________(mode).

NOTE: Since the values and premiums stated on this form may change over time, the estimated date upon which you will need to begin making premium payments from your own funds for the PROPOSED POLICY may also change. Estimates as to dates when policies will terminate or payments must begin assume the continuation of current (or guaranteed) factors, and such calculations are based upon the assumption that any premiums or interest due on loans are paid when due.

Policy Owner Signature _____________________________________________ Date ___________________

Agent/Company Officer Signature_____________________________________ Date ___________________

Agent Number ___________________________________________________

DM-1164-CA

DM-1174.Rev.5.15 1 of 6

ANNUITY SUITABILITY QUESTIONNAIRE FOR ALL APPLICANTS (Please attach additional sheets as necessary)

This questionnaire is designed to elicit information about your financial needs and investment objectives so that your agent can determine which product, if any, is suitable for you. Completion of this entire suitability questionnaire is mandatory. This form is used by the Company to help monitor the suitability of annuity sales for the benefit of the customer. Any alterations to this form must be initialed by the applicant(s).

Please Note: If you are signing on behalf of any of the named individuals (for example, you hold a Power of Attorney, etc.), the information provided should pertain to that individual, not you.

________________________________________ ____________________________ __________________________ NWL® Product Name NWL® Withdrawal Charge Period NWL® Premium Amount

Complete Section A if this is an Individual or Joint Owned Annuity

Complete Section B if Owner Is a Trust, Retirement Plan, or Corporation

SECTION A Please Note: A separate questionnaire must be completed by each owner if the relationship is not spousal. If the relationship is spousal, the Company assumes that all responses are the same for both individuals.

_______________________________________ _____________ ________________________ Name of Owner Age Date of Birth

_______________________________________ _____________ ________________________ Name of Joint Owner (if applicable) Age Date of Birth

SECTION B

Please Note: If the owner is an Irrevocable Trust, all questions must be answered with the Trust’s information. If the owner is a Revocable Trust, please see Page 6 for instructions on completing this form. If owner is a Retirement Plan or Corporation, all questions must be answered with the Plan or Corporation’s information.

________________________________________________________ ____________________________________ Name of Trust, Retirement Plan, or Corporation Date Established

FINANCIAL SITUATIONS AND NEEDS

1. Annual Income: $ _________________________ Annual Expenses: $ _________________________

2. Sources of Income (please enter the percentage of each source attributed to your annual income below; must total 100%): ____% Salary/Wages ____% Investments ____% Pension Plan/Lifetime Retirement Plan ____% Social Security

____% Other (please list) ________________________________________________________________________________________

3. Federal Tax Bracket: £ 10% £ 15% £ 25% £ 28% £ 33% £ 35% or higher

Please Note: If you reside with your spouse/domestic partner in a civil union, responses should reflect your joint financial information.

2 of 6

4. Approximate Net Worth after the purchase of this annuity (“Net Worth” means your total assets (excluding your primary residence and personal property, such as jewelry, furnishings, and vehicles) less your total debts (excluding mortgages on primary residence)): £ $0-$24,999 £ $25,000-$49,999 £ $50,000-$99,999 £ $100,000-$249,999 £ $250,000-$499,999 £ $500,000-$999,999 £ $1,000,000 or higher

5. What is the current investment vehicle for the financial resource(s) used for the funding of this annuity (please select all that apply)? £ Fixed/Indexed Annuity* £ Variable Annuity* £ Life Insurance* £ Reverse Mortgage/Home Equity Loan £ Mutual Funds/Stocks/Bonds/Money Market* £ Certificates of Deposit £ Checking Account £ Proceeds from a Death Benefit (please explain) ____________________________________________________________________ £ ** Other Investments (please list) _______________________________________________________________________________ **Note: IRA, 403b, 401k are plan/account types and are not valid answers *Please Note: If the source of funds is from an Annuity, Life Policy, or Investment Account, please submit your most recent Account Statement with your NWL® Application.

INTENDED USE OF THIS ANNUITY

6. What are your financial objective(s) in purchasing this annuity (please select all that apply)? £ Growth for Future £ Tax Deferral £ Save for Emergencies £ General Savings £ Retirement Income £ Estate Planning £ Immediate Income £ Safety of Principal £ Lifetime Income £ Other (please list) __________________________________________________________________

7. How do you anticipate taking distributions from this annuity (please select all that apply)? £ Annuitization £ Single lump sum £ Leave to beneficiary £ RMDs £ Partial surrenders (with penalty) £ 10% (or cumulative) Penalty-Free Withdrawals £ Loans £ Systematic Interest Withdrawals £ Lifetime Withdrawal Payments through Withdrawal Benefit Rider

8. How will contract values, if any, be paid at death (select one)? £ Payments to beneficiary over a period of five or more years £ Payment to beneficiary in a single lump sum

LIQUIDITY NEEDS AND FINANCIAL TIME HORIZON

9. What is your Liquid Net Worth after the purchase of this annuity? $_________________________

(“Liquid Net Worth” means the value of all of your assets that could readily convert to cash without imposition of fees or penalties (excluding your primary residence and personal property) less your total debts (excluding mortgages on primary residence))

10. Do you have sufficient cash available, liquid assets, or other sources of income for living expenses, health care, and emergencies after the purchase of this annuity? £ Yes £ No

11. Do you anticipate any significant changes in your household’s income, living expenses, or liquid assets during the surrender charge period of the annuity being purchased? £ Yes £ No

If yes, please explain ____________________________________________________________________________________________

_____________________________________________________________________________________________________________

(For example, do you expect a reduction in income caused by retirement or pension changes or by an increase in expenses such as housing, medical, nursing home, assisted living, or travel expenses?)

12. How many total years do you plan to keep this annuity in force with NWL®? £ 1-3 Years £ 4-6 Years £ 7-9 Years £ 10-12 Years £ 13-15 Years £ 16+ Years

13. When do you anticipate taking your first distribution from this NWL® annuity? (Please Note: This selection should not exceed your financial time horizon for question #12.) £ 1-3 Years £ 4-6 Years £ 7-9 Years £ 10-12 Years £ 13-15 Years £ 16+ Years

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FINANCIAL EXPERIENCE

14. Rate your investment knowledge (select one): £ Limited £ Average £ Extensive

15. Rate your risk tolerance for assets in this contract (select one): £ Conservative (minimal risk) £ Moderately Conservative (low risk/low volatility) £ Moderate (some risk/some volatility) £ Moderately Aggressive (high risk/high volatility) £ Aggressive (maximum risk/ seeking maximum returns)

16. What other financial products do you own or have previously owned (please select all that apply)?

£ None £ Stocks/Bonds/Mutual Funds £ Money Market/Brokerage Account

£ Certificates of Deposit £ Reverse Mortgage £ Real Estate Investment Trusts

£ Traditional Fixed or Fixed Indexed Annuity; Amount Owned $ ______________________________________

£ Variable Annuity; Amount Owned $ _____________ £ Life Insurance; Face Amount $ _______________

£ Other (please list) __________________________________________________________________________

17. What is the total amount of your existing assets, including investment and life insurance holdings but excluding your primary residence and personal property, remaining after the purchase of this annuity?

£ $0-$99,999 Provide Amount: $ ____________ £ $100,000-$249,999 £ $250,000-$499,999

£ $500,000-$999,999 £ $1,000,000 or higher

EXCHANGE OR REPLACEMENT

Note: Completion of this section is required regardless of your state’s definition of a replacement.

18. Is this an exchange or replacement of an annuity or life contract? £ Yes £ No a. If yes, please select the type of exchange or replacement. (If there are multiple replacements or exchanges, select all that apply.)

£ Penalty Free Amount (skip to question 18c) £ Partial Exchange or Replacement £ Full Exchange or Replacement

Type of Annuity or

Life Product

Company Name

Product Name

Purchase Date

Partial or Full Replacement

Amount

Total Dollar Amount of Surrender

Charge

Positive (+) or Negative (-)

Market Value Adjustment

Dollar Amount or N/A

Guaranteed Interest Rate

or N/A

Number of Years

Remaining in Surrender

Period

Example: Indexed Annuity

ABC Company

Indexer 2000 3/16/07 $25,000 $1500 (+) 525 2% 4

b. As a result of this transaction will you lose any existing benefits, experience any tax consequences, or be subject to increased fees or charges for riders or other product enhancements in proceeding with this exchange or replacement? £ Yes £ No (If no, proceed to question 18e) If yes, please explain: ______________________________________________________________________________________

________________________________________________________________________________________________________

c. Does the contract being replaced or exchanged have a guaranteed living benefit feature (example: Guaranteed Minimum Income or Guaranteed Withdrawal Benefit)? £ Yes £ No (if no, skip to question 18e) If yes, please state the current benefit base, percentage and frequency of step up, and the estimated annual payout amount.

________________________________________________________________________________________________________

If this is a Full or Partial Exchange or Replacement, you must provide us with a recent account statement and enter the requested information in the chart below. If no, skip to question 19.

4 of 6

d. Do you have to annuitize the contract with the existing carrier in order to exercise the income rider or feature? £ Yes £ No If yes, please explain: _________________________________________________________________________ ___________________________________________________________________________________________

e. Please explain how you will benefit from this annuity’s enhancements and improvements compared to the contract you are exchanging/replacing? _____________________________________________________________________________________ ________________________________________________________________________________________________________ ________________________________________________________________________________________________________

f. Have you had another annuity or life exchange or replacement (excluding this one)?

£ Yes – within the last 36 months £ Yes – within the last 60 months £ Yes – more than 60 months ago £ No

If yes, please provide timeframe and reason for exchanging or replacing: ____________________________________________

________________________________________________________________________________________________________

________________________________________________________________________________________________________

ADDITIONAL INFORMATION

19. Do you (or the trust beneficiary/grantor/settlor if a trust is the owner) or the annuitant currently reside in a nursing home or assisted living facility or plan to enter a nursing home or assisted living facility in the next 6 months? £ Yes £ No If yes, please explain: ____________________________________________________________________________________________

20. Have you (or the trust beneficiary/grantor/settlor if a trust is the owner) or the annuitant ever been diagnosed with, treated for, or consulted with a medical or healthcare advisor for mental deterioration due to an organic brain disorder, and/or been diagnosed as having a terminal illness or life expectancy of 12 months or less? £ Yes £ No If yes, please explain: ____________________________________________________________________________________________

If purchasing a Single Premium Immediate Annuity (SPIA), please skip to question 23. For all other fixed or fixed indexed annuity products, please proceed.

21. Do you understand and accept that you could possibly lose some of your principal if you surrender your NWL® policy early during the withdrawal charge period (if your cash surrender value is less than your premium)? £ Yes £ No

22. Do you understand and accept that your interest credits will fluctuate depending on the NWL® product you are purchasing and, if applicable, the strategy allocation you have selected? £ Yes £ No

23. What other information, if any, do you consider material in deciding to purchase this annuity? Please explain: _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________ _____________________________________________________________________________________________________________

AGENT CERTIFICATION

Explain why you have reasonable grounds for believing that the annuity that you recommended is suitable for the owner/applicant, including how you believe he/she will benefit from the purchase of this annuity: _________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________ _________________________________________________________________________________________________________________

By signing below, I certify that I have reasonable grounds for believing that my recommendation is suitable on the basis of facts disclosed by the owner/applicant as to financial situation and needs, investments, and other insurance products, and I realize that the Company may issue this annuity in reliance on my recommendation.

_____________________________________________________________________ __________________________________ Agent Signature Date

_____________________________________________________________________ __________________________________ Agent or Case Manager Email Address Annuity Agent Number (Email to be used for communication regarding suitability)

5 of 6

OWNER/APPLICANT CERTIFICATION

*Please note: In the instance of joint spousal ownership, both spouses must initial and sign below. By initialing beside each statement and signing below, I/we certify to the following:

______ ______ I have reviewed the Consumer Information Summary and Disclosure brochure that pertains to this annuity with my agent, and I have been reasonably informed of the various features of this annuity, including but not limited to the withdrawal charge period, withdrawal charges, charges for riders, and limitations on interest returns, before deciding to purchase this annuity.

______ ______ I have discussed my current financial and insurance products with my agent before deciding to purchase this annuity.

______ ______ I believe this transaction to be in my best interest, and I understand that if I am exchanging or replacing an existing annuity, I may incur surrender charges/fees and that I may not be able to reinstate this replaced contract.

______ ______ I understand that if I take money out of this product in excess of the free withdrawal amount provided in the contract during the withdrawal charge period, I will incur a withdrawal charge. (Not applicable for SPIA purchase)

______ ______ I understand that my agent will receive compensation/commission as a result of this transaction.

______ ______ I have reviewed this Annuity Suitability Questionnaire, and I understand its contents.

______ ______ I understand that the Company is relying on the information that I have provided on this questionnaire, and I certify that it is complete and accurate to the best of my knowledge.

______ ______ I have undergone a thorough discussion with my agent regarding the suitability of this annuity, and I certify that it is suitable for my circumstances.

______ ______ I understand that the Company does not warrant that its annuities will comply with Medicaid, Veterans’ Benefits, or any other state or federal programs and therefore qualification for such programs cannot be considered a factor in determining the suitability of this product.

_____________________________________________________________________ __________________________________ Owner/Applicant/Trustee Signature Date

_____________________________________________________________________ __________________________________ Joint Owner/Applicant/Co-Trustee Signature (if applicable) Date

6 of 6

INSTRUCTIONS FOR TRUSTS AS OWNERS

In instances in which a trust will be the owner of an annuity, the Company has specific requirements regarding what information must be captured on the Annuity Suitability Questionnaire. Please us the charts below to determine how the questionnaire(s) must be completed and what information needs to be included. In some instances, more than one questionnaire is required. In addition, please note the following: ! For multiple trustees who must act together, the Annuity Suitability Questionnaire must be signed by all trustees. ! Must also complete and submit the Trust Information Form (DM-1094).

Revocable Trusts

If: Then:

The Grantor/Settlor and Trustee are the SAME

The Grantor/Settlor of the Trust must complete the Suitability Questionnaire as to his/her own personal information. If there are multiple non-spousal grantors/settlors, a separate Suitability Questionnaire must be completed for each Grantor/Settlor.

The Grantor/Settlor and Trustee are DIFFERENT

The trustee(s) must complete the entire Suitability Questionnaire with the Trust’s information (net worth, goals, objectives, etc.). Do NOT include the trustee’s personal information, and the following modification must be made:

! For “Owner/Applicant/Trustee Signature,” the trustee must sign as trustee (e.g., Jane Doe, TTEE)

– And in addition –

The Grantor/Settlor of the Trust must complete and sign a separate Annuity Suitability Questionnaire with his/her own personal information Note: If the original Grantor is deceased, please follow the instructions for Irrevocable Trusts

Irrevocable or Non-Grantor/Settlor Trusts

The trustee(s) must complete the entire Suitability Questionnaire with the Trust’s information (net worth, goals, objectives, etc.) including the following modification:

! For ”Owner/Applicant/Trustee Signature,” the trustee must sign as Trustee (e.g., Jane Doe, TTEE)

Do NOT include the trustee’s personal information

Annual household income

Annual income below $25,000 could cause concern if the client doesn’t have adequate liquid assets and emergency savings.

Liquid Net Worth

Annuity premium equal to a significant portion of a client’s liquid net worth can impact the amount of liquid assets available for other circumstances.

Is an exchange or replacement involved? If so, emphasis must be placed on the features and fees associated with both the existing and proposed contract.

• There must be a clear benefit to exchange or replace one contract for another. • The surrender charges should not be excessive. • Has the client had other exchanges or replacements in the recent past?

National Western Life Practical Suitability Guidelines

Financial Situation and Needs Liquidity Needs and

Financial Time Horizon

Does the client have sufficient cash or other liquid assets for living expenses?

• Clients should have an emergency fund with which they are comfortable – typically at least 3 months worth of monthly expenses to

cover emergencies or other unexpected circumstances. No portion of emergency funds should be used to fund the annuity contract.

Exchange or Replacement

Information provided on this form is strictly intended as a guideline. These guidelines do not encompass all of the factors that must be taken into consideration when making a suitability determination. Suitability decisions are made based on the totality of the client’s individual circumstances.

You must in all cases still complete the Annuity Suitability Questionnaire, Form DM-1174 (or any future revisions thereof). For additional information or questions pertaining to a specific situation, please contact the Suitability Department at 800-531-5442 ext. 313

For Producer use only – not for use with the public

DM-1189

For Agent Use Only- This document has not been approved under the advertising laws of your state for dissemination to individual purchasers.

Can I call NWL before writing an application to

verify suitability?

National Western Life Annuity Suitability Review Process

What is Annuity Suitability? Annuity Suitability involves ensuring there is a reasonable basis to believe the recommendation of an annuity is sensible and appropriate given a client’s particular objectives, goals, and financial situation, among other factors. The goal of NWL’s Suitability Review Team is to ensure that clients are informed of the product features and limitations, while having their financial needs and objectives appropriately addressed and aligned with the annuity for which they are applying.

What additional forms are required?

You may speak with one of our Suitability Analysts prior to writing an application to discuss the specifics of the case; however we cannot guarantee suitability over the phone. Our Suitability Analysts can be reached by dialing 1-800-760-3434 ext 313, 400, or 525. Final determination will be made once all documentation has been reviewed in our office.

• Annuity Suitability Questionnaire DM-1174 (most current revision date). *See the Annuity Suitability Training Requirements by State (SA-1299) for a list of applicable states.

• Current Account Statement, if a replacement is occurring. • Any additional information that might be requested in order to

make a determination of suitability.

DM-1234 Page 1 of 6


National Western must receive a completed Annuity Suitability Questionnaire in order to make a decision regarding the suitability of the recommended product. If the client is not willing or able to provide all the information, unfortunately the Suitability Team will decline the sale. In addition, questions left blank will cause delays in the review process.

What assets are considered liquid?

Liquid assets are those that can be quickly converted to cash with little to no penalty. Checking & savings accounts, matured CDs, annuities that are beyond the withdrawal charge period, and certain mutual funds are a few examples.

Does NWL require that the client retain a certain amount

of liquid assets after the annuity purchase?

Can my client “opt-out” of providing financial data?

While there is no rule set in stone, a general guideline is for a client at or nearing retirement age typically age 65+ to have at least the value of 1.5 – 2 years of their annual expenses liquid in the event of an emergency after the purchase of one of our annuities. Example: Jane Smith, age 65, retired, earns $32,000 annually with annual expenses of $18,000. She should have at least $27,000 in liquid assets remaining after the annuity purchase. It is expected that in most instances, clients of all ages will have a minimum of 6 months worth of expenses liquid. Typically, annuities – including the one being applied for – should not make up more than 60% of a client’s liquid net worth. The older the client, the less of his/her assets we’d expect to see allocated to long term annuities.

Page 2 of 6


A: Net Worth =Total Existing Assets – Liabilities Total Existing Assets should include all liquid and illiquid resources (except primary residence, personal property, and the premium for the annuity purchase). Liabilities should include (but are not limited to) any debts, including all outstanding loans. Some common examples of each are listed below. Note: The value of the primary residence should not be included in any of the questionnaire calculations

Q: What assets are considered illiquid?

A: An illiquid asset is an asset that isn’t easily or quickly converted to cash and/or cannot be sold or exchanged for cash without a penalty or other loss in value. Deferred annuities still within the withdrawal charge period, personal property, and real estate are just a few examples.

Q: How do I calculate my client’s Net Worth?

Vehicle loans Credit card debt Outstanding medical bills Mortgage on primary

residence Mortgage on rental

property Other out of pocket

expenses

Liabilities

Illiquid Assets

Real Property excluding primary residence, such as investment/rental property

Retirement Accounts including 401(k), 403(b), Annuities, Pension Plans (for clients under 59 ½)

Life Insurance Annuities in deferral

Cash Checking/Savings Accounts Matured CDs Penalty free amounts from deferred annuities Some Stocks/Mutual Funds/Bonds

Liquid Assets

Tot

al E

xist

ing

Ass

ets

Vehicle loans Credit card debt Outstanding medical bills Mortgage on primary

residence Mortgage on rental

property Other out of pocket

expenses

Liabilities

Page 3 of 6


A replacement should have a noticeable benefit to the client for the duration of the annuity, not just at issue. You need to be familiar with the product being replaced in order to perform a side-by-side comparison. Product Comparison Compare the features of the current and new annuity to ensure there is a foreseeable benefit to the client for the duration of the contract, beyond issue. Loss of Benefits Determine if the client is losing any additional benefits or riders on the current product. Common examples of additional benefits would include income riders, enhanced death benefits, and guaranteed fixed interest rates. Also, if the client is nearing the end of the withdrawal charge period on the current contract, it could be more beneficial for the client to continue the existing contract through the completion of the surrender period. Surrender Charges Typically, we will not issue an annuity if the client is at a net loss at issue. A net loss occurs when the account value of the new annuity at issue is less than the value of the annuity that was replaced. One of our bonus products that offer an upfront, immediate bonus might be considered more suitable than a non-bonus product so long as the client’s financial goals & objectives are being met with that product. Remember also, however, that bonus amounts are considered expenses that the Company incurs, and all expenses are taken into consideration when interest rates, caps, and participation rates are established and reset.

Due to the bonus vesting schedule on the Income Outlook Plus 5, and the fact that the rider can be removed, we do not allow it to be used to recover replacement surrender penalties. This rider features a bonus that is subject to a 10-year vesting schedule in terms of the annuity’s account value and only vests immediately in the event of death or election of lifetime income, which means the client is still not whole in the account value at issue. In addition, the interest rate or “roll-up” that is credited under this rider is also not considered as a means to recover surrender charges as it is applicable only for lifetime income and not the account value or death proceeds.

Can I use the bonus on the Income Outlook Plus 5 income rider to offset surrender charges on a

replacement?

Does NWL have any guidelines regarding the

suitability of replacements?

Page 4 of 6


Can the client submit a letter to NWL acknowledging various circumstances such as penalties on a replacement or other suitability

items if they wish to purchase a non-bonus product or forego other suitability guidelines?

While we do appreciate the client’s desire to purchase one of our annuities, we do not accept signed acknowledgements of penalties or other suitability related items from the client in lieu of suitability. However, additional information from the client about individual circumstances is always welcome and can be helpful with the suitability process. The Suitability in Annuity Transactions regulation puts the burden of determining suitability on the agent and the insurer, not the client.

My client currently resides in an assisted living facility or nursing

home. Will this be considered unsuitable and automatically declined?

A client residing in an assisted living facility will not result in an automatic decline; however, the client should have sufficient remaining liquidity after the purchase of the annuity to cover any possible increased expenses that might occur, and details regarding the type of assistance received should be provided. Additional information may be requested if needed. Please note, National Western does not accept deferred annuity applications from clients residing in nursing homes, regardless of a POA acting on his or her behalf.

Page 5 of 6


Additional Useful Information

• Corrections made on the Annuity Suitability Questionnaire must always be initialed by the client. We cannot accept the agent’s initials in lieu of the client’s initials.

• The information the client provides to National Western is used in determining whether the sale is suitable. Please do not omit any information.

• A Suitability Analyst will contact you or your case manager by the email address provided on the Suitability Questionnaire or through our website, www.nationalwesternlife.com, for any additional information or corrections that may be needed to determine suitability. A prompt and thorough reply will expedite the handling of your pending applications.

• Periodic Suitability Confirmation Surveys may be mailed to clients confirming information provided during the application process.

• From time to time National Western Life will make revisions to the Annuity Suitability Questionnaire. To ensure timely processing of your applications please be sure to use our most current revisions. The current revision is always available on our website or through use of the Electronic Application (eApp).

• A member of The NWL® Suitability Team can be reached at: Phone: (800)-760-3434 Ext. 313, Ext. 400, Ext. 525 Email: [email protected]

Page 6 of 6

Deferred Annuity Certifications It is the policy of National Western Life Insurance Company® (the Company) not to issue a deferred annuity if the owner, applicant, trustee, or annuitant is in a Nursing Home Facility or has a mental impairment/medical condition as described below. As a result, the Company requires certifications of the named individuals in order to ensure that this policy is enforced and is relying on these certifications in its decision to issue the deferred annuity for which application is being made. Please note that if you are signing on behalf of any of the named individuals (for example, you hold a Power of Attorney, etc.), then the certification pertains to that individual, not to you.

A Nursing Home Facility is a facility that meets all of the following criteria: 1. It is licensed as a nursing home by the state where it is located; and 2. It is a separate facility or a distinct part of another facility physically separated from the rest of such facility; and 3. It provides nursing care to individuals who are not able to fully care for themselves and/or who require confinement; and 4. Its primary function is to provide continuous 24 hour-a-day nursing care, room, and board, and it charges for these services. The care must be performed under the direction of a Physician or a registered nurse (RN) or a licensed practical nurse (LPN).

Annuitant Certification

I certify all of the following to be true, with respect to the Annuitant, by signature below: • I currently do not reside in a Nursing Home Facility and do not plan to enter a Nursing Home Facility in the

next 6 months. • I have never been diagnosed with, treated for, or consulted with a medical or healthcare advisor for mental

deterioration due to an organic brain disorder such as dementia, Alzheimer’s disease, or brain injury. • I have never been medically diagnosed as having a terminal illness or life expectancy of 12 months or less. __________________________________________ _________________ Annuitant Signature Date Owner/Applicant/Trustee Certification (if other than annuitant, complete this section)

I certify all of the following to be true by signature below: • I currently do not (or the trust beneficiary/grantor/settlor if a trust is the owner) reside in a Nursing Home

Facility and do not plan to enter a Nursing Home Facility in the next 6 months. • I have never been diagnosed with, treated for, or consulted with a medical or healthcare advisor for mental

deterioration due to an organic brain disorder such as dementia, Alzheimer’s disease, or brain injury. • I have never been medically diagnosed as having a terminal illness or life expectancy of 12 months or less. __________________________________________ _________________ Owner/Applicant/Trustee Signature Date __________________________________________ _________________ Joint Owner/Applicant/Co-Trustee Signature Date (if applicable) Agent Certification

By signing below, I certify that I have no reasonable grounds to believe that the foregoing certifications are false. __________________________________________ ______________ _______________ Agent Signature Agent Number Date DM-1243.Rev.9.12

DM-1246

For Agent Use Only – This document has not been approved under the advertising laws of your state for dissemination to individual purchasers.


850 East Anderson Lane, Austin, TX 78752

FIXED INDEXED ANNUITY PORTFOLIO

At National Western Life Insurance Company® we know that without you, our valued agent, there is no us. So we want to be there for you,

standing at the ready to meet your needs and answer any questions you might have.

Customer Service

support for agents and Key Distribution Partners

Fax 512.719.8512 - Press 1

Licensing and Contracting

Fax 512.719.8506 - Press 2

Domestic Marketing

Product and pre-sale support for agents and Key Distribution Partners

Fax 512.339.8350 - Press 3

New Business

status of business submitted, outstanding requirements, transfers, and rollovers

Fax 512.719.8507 - Press 4

www.nationalwesternlife.com

HERE’s HOW TO cONTAcT Us

800-760-3434

Name ________________________________________________________________________________________

Number ______________________________________________________________________________________

Name ________________________________________________________________________________________

Number ______________________________________________________________________________________

YOUR NATIONAL WEsTERN LIFE cONTAcTsWho often helps you out? Have their number readily available!

Page 1 of 9

Surrender Charge Period 13 Years

10% W/DOnce annually after 1st contract year

cumulative to 50%

Issue Age

Owner is also AnnuitantOwner/Annuitant=> 0-80

(0-57 in TX, 0-56 in OH)

If Owner is NOT

the Annuitant

Annuitant=> 0-80

(0-57 in TX, 0-56 in OH)

Owner=> 0-85

Annuitization *After 5th contract anniversary for minimum of 5 years

(In FL: 1st annv - 10+ yrs, 2nd annv - 7+ yrs, 3rd annv - 5+ yrs, or life annuitization)

Available Interest

StrategyA, B, D

Bonus No

Withdrawal Benefit Riders Income Outlook and Income Outlook Plus 5 (Not Available in All states)

Additional BenefitsMedical stay Waiver, Accidental

Death Benefit, Terminal Illness Benefit

NWL Ultra Classic® - FPDA

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NWL®

For agent use only. Not all products, benefits, and riders are available in all states. Additional benefits may have issue age restrictions.*Minimum Annuitization Options

Interest Strategy Options

Formula-Linked Index

(Interest based on a formula linked in

part to an index)

A B D

Annual Ratchet w/Monthly Avg Fixed Interest Annual Ratchet w/Monthly cap

s&P 500® N/A s&P 500®


Page 2 of 9


10% W/D Once Annually after 1st contract year

Issue Age


(0-56 in TX, 0-55 in OH)

If Owner is NOT

the Annuitant

Annuitant=> 0-80

(0-57 in TX, 0-56 in OH)

Owner=> 0-85

Annuitization* After 5th contract anniversary for minimum of 5 years

Available Interest

StrategyA, B

Bonus 5% in year 1 / 4% Years 2-5


Additional BenefitsMedical stay Waiver,

Accidental Death Benefit

NWL Ultra Benefit® - FPDA

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��

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NWL

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part to an index)

A B

Annual Ratchet w/Monthly Avg Fixed Interest

s&P 500® N/A


Page 3 of 9

Surrender Charge Period15 Years

(For DE, IL, IN, MA, MN, NJ, PA,UT, WA: 9 Years)

10% W/D Once annually after 1st contract year

Issue Age


(0-55 in TX, 0-54 in OH)

If Owner is NOT

the Annuitant

Annuitant=> 0-80

(0-55 in TX, 0-54 in OH)

Owner=> 0-85


(In IL and FL: 1st annv - 14+ yrs, 2nd annv - 7+ yrs, 3rd annv - 5+ yrs, or life annuitization)

Available Interest

StrategyA, B, D

Bonus9% in year 1 / 4.75% years 2 - 5

(For DE, IL, IN, MA, MN, NJ, PA,UT, WA: 2% Years 1 - 5)


Additional Benefits None

NWL Ultra Future® - FPDA

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NWL

®




part to an index)

A B D

Annual Ratchet w/Monthly Avg Fixed Interest Annual Ratchet w/Monthly cap

s&P 500® N/A s&P 500®


Page 4 of 9


10% W/D Once annully every year

Issue Age

Owner is also Annuitant Owner/Annuitant=> 0-80

If Owner is NOT

the Annuitant

Annuitant=> 0-80

Owner=> 0-85



Available Interest

StrategyA, B, D

Bonus 2% in years 1-5



NWL® Ultra Value - FPDA




part to an index)

A B D

Annual Ratchet w/Monthly Avg Fixed Interest Annual Ratchet w/Monthly Cap

S&P 500® N/A S&P 500®

��

� � � �V A L U E

NWL®



10% W/D Once annully every year

Issue Age


If Owner is NOT

the Annuitant

Annuitant=> 0-80

Owner=> 0-85

Annuitization *

After 5th contract anniversary for minimum of 5 years


(In IL: 1st annv - 14+ yrs, 2nd annv - 7+ yrs, 3rd annv - 5+ yrs, or life annuitization)

Available Interest

StrategyA, B, D, K

Bonus No



NWL Global Lookback® - FPDAInternational Indexes and the Advantage of a “Lookback” Feature in this Annuity Add Valued Protection for your Hard-Earned Money!

Page 5 of 9




part to an index)

A B D K

Annual Ratchet

w/Monthly AvgFixed Interest

Annual Ratchet

w/Monthly cap

Annual Ratchet

w/Monthly Average

s&P 500® N/A s&P 500®s&P 500®, Nikkei 225,

Euro stoxx 50®, Hang seng

For agent use only. Not all products, benefits, and riders are available in all states. Additional benefits may have issue age restrictions.

Page 6 of 9



Issue Age


If Owner is NOT

the Annuitant

Annuitant=> 0-80

Owner=> 0-85

Annuitization On 22nd contract anniversary for minimum of 5 years

Available Interest

StrategyA, B, D, K

Bonus 5% of premiums received in Year 1 - Subject to 10 year vesting schedule



Terminal Illness Benefit

NWL Impact 7® - FPDA

�




part to an index)

A B D K

Annual Ratchet


Annual Ratchet

w/Monthly cap

Annual Ratchet

w/Monthly Average

s&P 500® N/A s&P 500®s&P 500®, Nikkei 225,


Page 7 of 9


NWL Impact 7S® - FPDA




part to an index)

A B D K

Annual Ratchet


Annual Ratchet

w/Monthly cap

Annual Ratchet

w/Monthly Average

s&P 500® N/A s&P 500®s&P 500®, Nikkei 225,



10% W/D After 1st contract year

Issue Age


If Owner is NOT

the Annuitant

Annuitant=> 0-80

Owner=> 0-85

Annuitization After 10th contract anniversary for minimum of 5 years

Available Interest

StrategyA, B, D, K


Withdrawal Benefit Riders Income Outlook and Income Outlook Plus 5 (Not available in all states)



�


Page 8 of 9



Issue Age


If Owner is NOT

the Annuitant

Annuitant=> 0-80

Owner=> 0-85

Annuitization On 22nd contract anniversary for minimum of 5 years

Available Interest

StrategyA, B, D, K





NWL Impact 10® - FPDA




part to an index)

A B D K

Annual Ratchet


Annual Ratchet

w/Monthly cap

Annual Ratchet

w/Monthly Average

s&P 500® N/A s&P 500®s&P 500®, Nikkei 225,


�

Page 9 of 9

Income Outlook

General Available at issue only with Fixed Indexed Annuities

Withdrawal Payment Available on first year anniversary. Annuitant must be minimum age 60

Annual Rider Charge - Current* 0.35% of annuity’s Account Value on Policy Anniversary

Accumulation Period

Withdrawal Payment Base

(APWPB)

4% interest guaranteed during accumulation period

Rider Bonus N/A

Income Outlook Plus 5

General Available at issue only with Fixed Indexed Annuities

Withdrawal Payment Available on first year anniversary. Annuitant must be minimum age 60.

Annual Rider Charge - Current* 0.75% of the APWPB

Accumulation Period

Withdrawal Payment Base

(APWPB)

4% interest guaranteed during accumulation period

Rider Bonus 5% - Subject to 10 year vesting schedule

For agent use only. Not all products, benefits, and riders are available in all states. Additional benefits may have issue age restrictions.*Current as of the date of this publication and subject to change.

w w w . n a t i o n a l w e s t e r n l i f e . c o m

REPLACING YOUR LIFE INSURANCE POLICY OR ANNUITY?

Are you thinking about buying a new life insurance policy or annuity and discontinuing orchanging an existing one? If you are, your decision could be a good one--or a mistake. Youwill not know for sure unless you make a careful comparison of your existing benefits and the proposed benefits.

Make sure you understand the facts. You should ask the company or agent that sold you yourexisting policy to give you information about it.

Hear both sides before you decide. This way you can be sure you are making a decision that is inyour best interest.

We are required by law to notify your existing company that you may be replacing their policy.

________________________________________________ _______________________Applicant’s Signature Date

________________________________________________ _______________________Agent’s Signature Date

NOTICE REGARDINGREPLACEMENT

SA-8446-CA(Rev.3/98) Applicant’s Copy - WHITE Home Office Copy - Yellow

N ATIONAL WESTERN LIFE INSURANCE COMP A N Y8 5 0 E A S T A N D E R S O N LA N E • AU S T I N , T E X A S 7 8 7 52 – 1 6 0 2

SA-8505.Rev.1.14

850 East Anderson Lane, Austin, TX 78752

Proposed Insured/Annuitant: Name ________________________________________________________________ SSN: xxx-xx-__________ (last 4 digits)

Funds Coming From:

Existing Company Name _________________________________________________________________________________

Street Address _________________________________________________________________________________________

City _____________________________________________________ State _____________________ Zip _______________

Existing Company Phone Number (_______)__________________________ Area Code

Policy / Account to be Transferred:

Policy/Account No. _____________________________________________________ (Attach recent statement)

Type of policy/account: Annuity Life Ins Brokerage Acct Certificate of Deposit TSA/403(b) Other

Policy/Account Owner(s) Name(s) __________________________________________________________________________

The undersigned hereby requests and directs that the following action be taken in order to transfer the policy/account

fund identified above: Entire Account Liquidation/Transfer/Rollover Partial $________________ or ________%

QUALIFIED ACCOUNT(S)

Minimum Required Distribution Instructions **Must complete if applicant is age 70 or older**

Calculate and withhold the Minimum Required Distribution for Tax Year _______ and send to the policyholder prior to

transferring funds.

I have already satisfied my current year Minimum Required Distribution.

I will satisfy my current year distribution from another qualified account.

Employer Owned/Sponsored Retirement Plan Distribution/Rollovers

401k and/or other Employer owned retirement plans will require the applicant to do phone liquidation/transfer or will require plan distribution paperwork (they will not accept this form).

Direct Transfer/ Rollover of a Qualified Account

Surrender of an established qualified contract(s) under the Internal Revenue Code for reinvestment in a new qualified contract as follows: IRA ROTH IRA SEP IRA

TSA/403(b) to IRA (a direct rollover which requires a “qualifying event”)

Qualifying events: Age 59 ½ Terminated from Service (Date of Termination ______________)

1035 EXCHANGE OF A NON-QUALIFIED ANNUITY OR LIFE INSURANCE POLICY

1035 Tax-Free Exchange (for 1035 exchange of partial and entire accounts) The undersigned intends the execution of this document to be part of a tax-free exchange of policies or contracts under Section 1035 of the Internal Revenue Code, and understands that if National Western Life underwrites and issues a new policy or contract on the above insured, then National Western Life intends to surrender the above policy or contract for its cash value and that the above policy or contract will no longer be in force or effect as of the coverage termination date. National Western Life is hereby directed to apply the surrender proceeds upon receipt to the purchase of a policy or contract according to the written instructions it has received.

Absolute Assignment (1035 exchange of an entire account only) For value received, the undersigned owner hereby assigns and transfers all rights, title and interest in the above described policy or contract to National Western Life Insurance Company, hereafter known as “National Western Life”. National Western Life shall be entitled to all ownership rights, privileges, options and powers under said policy or contract.

**In accordance with the Tax Equity and Fiscal Responsibility Act of 1982, furnish a statement to National Western Life and to the former contract holder of the cost basis in the contract.** SA-8600.Rev.5.14 Page 1 of 2

AUTHORIZATION TO TRANSFER

FUNDS TO NATIONAL WESTERN LIFE

CERTIFICATE OF DEPOSIT (MATURITY DATE MUST BE WITHIN 60 DAYS OF TRANSFER)

Liquidate Certificate of Deposit on the maturity date of ____/____/____.

Liquidate Certificate of Deposit upon receipt of this request. I am aware of any penalty that may be imposed from an early withdrawal. Please Initial ____________ Qualified _______________ Non-Qualified

BROKERAGE ACCOUNT/MONEY MARKET ACCOUNT **MEDALLION SIGNATURE GUARANTEE MAY BE REQUIRED**

Qualified _______________ Non-Qualified

TAX WITHHOLDING ELECTION FOR PAYEES OF SURRENDERS

Even if the undersigned elects not to have federal income tax withheld, the undersigned acknowledges that he/she is liable for payment of federal income tax on the taxable portion of the surrender. The undersigned also may be subject to tax penalties under estimated tax payment rules if the payments of estimated tax and withholding, if any, are not adequate.

It is further agreed that National Western Life has made no representations and that it has no responsibility or liability concerning the undersigned’s tax treatment under the Internal Revenue Code.

The undersigned agrees and acknowledges that a taxable event may occur in the event that the cash surrender value of a National Western Life annuity policy is used to purchase a life insurance policy.

I want to have federal income tax withheld from my surrender. Please withhold $ _________________ or ____________ %

I do not want to have federal income tax withheld from my surrender.

LOST POLICY/ CONTRACT STATEMENT

If the policy/contract is not attached, I/We hereby certify that the above numbered contract has been lost or destroyed and, to the best of my/our knowledge and belief, is not in anyone’s possession.

AUTHORIZATION TO RELEASE INFORMATION

I/We hereby grant permission to release all information pertaining to this requested transaction to National Western Life Insurance Company as long as this transaction is pending.

The undersigned is aware of any surrender/withdrawal penalties that may apply and the undersigned authorizes the transaction described above. The undersigned also understands and is aware that there may be lost interest and/or market value changes that may occur during and after this transaction. The undersigned represents and agrees that National Western Life is participating in this transaction at the undersigned’s specific request and as an accommodation to the undersigned, and as such the undersigned does not hold National Western Life responsible for any surrender/withdrawal penalties, lost interest, market value changes, and/or any and all other decreases in value to the above accounts as a result of this transaction. Dated at:_________________________________________ this _______ day of _________________, 20_______ (City, State)

Signature: __________________________________

Insured/Annuitant

Signature: __________________________________

Owner

Signature: __________________________________

Joint Owner

Signature: __________________________________

Spouse

If you reside in one of the following community property states, your spouse must also sign: AZ, CA, ID, LA, NM, NV, TX, WA and WI.

SA-8600.Rev.5.14 Page 2 of 2

Medallion Signature Guarantee (if applicable)

MINIMUM DISTRIBUTION REQUIREMENTS DISCLOSUREFor all annuitants age 70 and older

Dear Annuity Contract Owner:

We want to be sure you are aware of the Internal Revenue Code Regulation Section 1.401(a)(9), minimum distributionrequirements that may affect your annuity contract. Please read this form carefully, sign, and send a copy with your applica-tion.

If you attain(ed) age 701⁄2 during the current calendar year and have a qualified retirement plan or IRA, the Internal

Revenue Code normally requires that you take your first distribution between January 1 of this year and April 1 of thenext calendar year (a later date may apply for governmental or church plans). Subsequent annual distributions arerequired to be taken no later than December 31 of each year, which means that your second minimum distribution mustbe taken no later than December 31 of the year following the year in which you attain age 701⁄

2.

If you attained age 701⁄2 prior to the current calendar year and have a qualified retirement plan or IRA, your minimum dis-

tribution must be taken no later than December 31 of this year.

Depending upon your personal tax situation, it may be necessary for you to begin taking the required minimum distribu-tion from your annuity contract. If this is the case, your agent can furnish the forms necessary to set up your minimumdistribution. Please be aware that once you begin taking this distribution, you cannot change your selection. You shouldbe aware that your annuity may have surrender charges or market value adjustments which will apply to your requiredminimum distribution. Additionally, you may not be permitted by certain annuity contracts to take any withdrawalswithout incurring a withdrawal charge during the first policy year.

AS WITH ALL PERSONAL TAX MATTERS, WE STRONGLY SUGGEST THAT YOU CONSULT YOUR TAXADVISOR BEFORE MAKING A DECISION ABOUT YOUR MINIMUM DISTRIBUTION. If you fail to take therequired distribution by the appropriate deadline, you may be subject to an excise tax equal to 50% of the amount whichshould have been withdrawn but was not.

Remember, unless you elect a minimum distribution, we must assume that you have met your minimum distributionrequirements for this year and do not wish to elect to set up automatic distributions.

National Western Life Insurance Company® does not provide tax advice. If you have any tax questions, please consultwith your tax advisor.

I understand that it is my sole responsibility to comply with the Internal Revenue Code requirements concerning mini-mum distributions.

Owner Date

SA-8714.Rev.4.12


850 EAST ANDERSON LANE • AUSTIN, TEXAS 78752–1602

Please be advised that the sale or liquidation of any stock, bond, IRA, certificate of deposit, mutual fund, annuity, orother asset to fund the purchase of an annuity or life insurance policy may have tax consequences, early withdrawalpenalties, or other costs or penalties as a result of the sale or liquidation.

You may wish to consult an independent legal or financial advisor before selling or liquidating any assets and prior tothe purchase of any life or annuity products.

I have received a copy of this disclosure and I understand its contents.

Applicant Signature

Date

NOTICE TO CALIFORNIA RESIDENTSAGE 65 OR OLDER

SA-9252-CA.Rev.8.09White - Applicant Copy

Yellow - Agent / Company Copy

REPLACEMENT LIST

Note to the Agent: use this list to report to National Western all policies or contracts to be replaced in connection with the pending application. INSURER INSURED Existing Contract (As it appears on the Policy) (As it appears on the Policy) or Policy Number _______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

________________________________ ___________________ Applicant Name Date

SU-6611.Rev.4.12

TRUST INFORMATION FORM

In order to clarify the request for the ownership and/or beneficiary of an annuity or life insurance contract to be a trust, please provide the following information. All questions must be answered fully. Attach additional sheets as needed.

National Western Life Insurance Company (the Company) will continuously rely on information provided in this form. It is the responsibility of the Trustee(s) to notify the Company immediately of any changes to the Trust and/or Beneficiaries designated in the Trust.

Trust Information

Formal Name of Trust __________________________________________________________________________________

Date Trust Executed _________________________ Trust Tax ID# _____________________________________________ Trust Type (select one) � Revocable � Irrevocable Name of Grantor(s)/Settlor(s) _____________________________________________________________________________

Trustee Information

Name of Trustee(s) Date of Birth Address

____________________________ ___________________ _________________________________________________

____________________________ ___________________ _________________________________________________

____________________________ ___________________ _________________________________________________

Co-Trustees (if applicable) (select one) � May act independently � Must act together Do the Trustees have power, without limitation, over insurance transactions (including the purchase of a life insurance or annuity contract)?

� Yes � No If no, please explain: ______________________________________________________________________

Contingent Trustee(s) (if applicable) __________________________________________________ _______________________________________________

��

��

��

By signing below, the Trustee(s) certifies that the terms of the insurance product(s) being applied for conforms to the income distribution requirements, if any, of the Trust. The Company has the right to request additional information about the Trust if deemed necessary for reviewing or issuing a new or existing policy. The Company may rely on information provided on this form and has no further obligation to investigate the terms of the Trust or the authority of the Trustee(s).

_________________________________________________________ ____________________________________ Trustee Signature Date

_________________________________________________________ ____________________________________ Co-Trustee Signature Date

_________________________________________________________ ____________________________________ Co-Trustee Signature Date

DM-1094.Rev.6.11

NWL® Policy/Contract # ______________________ (if policy is new, leave blank)

Documents

APPLICATION FOR ANNUITY 850 East Anderson Lane • Austin ... · 6/24/2015 · APPLICATION FOR ANNUITY 850 East Anderson Lane • Austin, Texas 78752-1602 01-9046-14 ANNUITANT: