First Name:
Last Name:
Company Name:
Email Address:
Phone Number:
State:
I am a(n):
Your Broker / Dealer Name:
Assets under management:
% of fee-based business:
How did you hear about us?
Have clients who need more tax deferral?
Select all of the following CRM software you currently use:
Select all of the following reporting software you currently use:
Select all of the rebalancing software you currently use:
Select all of the aggregation software you currently use:
IARD/CRD#:
Have clients with variable annuities?
Select all of the organizations you belong to, and where you custody assets:
Select all of the following bond fund familes you use in client portfolios:
Select all of the following alternative fund families you use in client portfolios:
Select all of the following asset classes you use in client portfolios:
Please list which, if any, TPIAs you currently use (separated by commas):
I authorize that I am a financial professional.

The Minds Behind 2010's Financial Services
Company of the Year

A Case Study for Financial Professionals

Tell us where and to whom to send your free case study:

Note: This is provided free of charge by Jefferson National.

An investor should carefully consider the investment objectives, risks, charges and expenses of the investment before investing or sending money. For a prospectus containing this and additional information, please contact your financial professional. Read it carefully before investing. The summary of product features is not intended to be all-inclusive. Restrictions may apply. The contracts have exclusions and limitations, and may not be available in all states or at all times.

Variable annuities are investments subject to market fluctuation and risk, including possible loss of principal. Your units, when you make a withdrawal or surrender, may be worth more or less than your original investment.

Variable annuities are long-term investments to help you meet retirement and other long-range goals. Withdrawal of tax-deferred accumulations are subject to ordinary income tax. Withdrawals made prior to age 59 ½ may incur a 10% IRS tax penalty. Jefferson National does not offer tax advice. Annuities are not deposits or obligations of, or guaranteed by any bank, nor are they FDIC insured.

Monument Advisor is issued by Jefferson National Life Insurance Company (Dallas, TX) and distributed by Jefferson National Securities Corporation, FINRA member. Policy series JNL-2300-1, JNL-2300-2.

Form #: JNL201108-A088

The Minds Behind 2010's Financial Services Company of the Year

A Case Study for Financial Professionals

The Minds Behind 2010's Financial Services
Company of the Year