R2009-23 ESTABLISHING DEFERRED COMPENSATION PROGRAM

Home Browse Search

Al'PI.ICA7'ION 1�012 CROUY FLE\IBLE PURCIIASE PAl'N1EN"C DT,FLRRI:D VARIAI3LE ANNUI7'Y CONTRA(..1. �+ndrnvriden bJ� Nationwidc Lifc Insur:�ncc Contpany ` ,: Onc Nationwidc Plazn —— Columbus,OLio 4321,5 LAI'PLICANT �r"fi c7— �{ C 9 '�''� �LL l�/Qls 7 � (Uie "Applicant"), tipplies to be the Contract Owncr of a Group Flexible Purch<ise Yayment Defemed Variable Annuity Contract (thc "Contracf') undcrwrittcn by Nationwide l.ife lnsurtmcc Company ("Na[ionwide"). 77:e Group I�le�ible Purchase Yayment Def'erred Variable Annuity Contract applied fi>r will become effective on the"F:fTective Date of Ccmtract"if the initial Purchase Payment aud this application are accepted by Nationwide. In the event tl�e initial Purchase Payment or this application are not accepted.Nationwide's liability will Ue limiteJ to a return of the initi.il P«rchase Payment,a�id any subsequent Purchase Payments remittcd. PURCHASE PAYMEI�'I' Applicant agrees to perniit Particip;urts in its Plan to allocate Purchase Payments to the following Underlying InvesUuent Options that Nationwide agrees to make available as of the"Effective Date of Contract". Nationwide Investor Destinations Funds Select Saectrum Series Select Snectrum Series-fCont'd) Conservative Fund- Service Class American Century Value Fund- Nationwide S&P SOOOO Indes Fund- Investor Class Institutional Service Class Moderately Conservative Fund- American Century Vista Fund- Nationwide Small Cap Index Fund- Service Class Investor Class Class A Moderate Fund- Service Class American Centu�y Real Estate Fund- Nationwide Variable Insurance Trust: Investor Class Nationwide Multi-Manager NVI"I'Small Company Trust- Class I Moderately Aggressive Fund- Brown Capital Mana,ement,Inc. Merrill Lynch Natural Resources Ftmd- Service Class Small Company Fund-Inst. Class Class A Aggressive Fund- Service Class Dreyfus Appreciation Fund,Inc. Neuberger Berman Genesis Fund- Conservative Fund- Service Class Dreyfus Premier Small Cap Value Trust Class Fund-Class R Moderately Conservative Fund- JP Morgan International Equity Neuberger Berman Socially � Service Class Fund-Select Shares Responsive Fund-Investor Class JP MarQan Mid Cap Value Fund- Neuberger Berman Genesis Fund- Class A T'rust Class Nationwide Bond lnde� Fund-Class A Oppcnheimer Global Fund-Class/1 Nationwide International Inde� Pund- PIMCO Total Return Fund- Class A Class A T. Rowe Price Growth Stock Fund- Nationwide Lar�e Cap Growth 7'ortfolio Advisor Class Nationwide Mid Cap Market Indes "Templeton Foreign Fund-Class A Fund- Class A Van K�unpen Growtl��.Income Nationwide Money Market Fund- Fund-Class A Prime Shares Waddell&Reed Advisor FIigh � Nationwide Fund-Class D Incomc Fund-Class Y OP'I'IONAL FI�ED ACCOUNT �Yes ❑No Applicant elects to add via endorsement to the Contrac[,a Pixed Account option funded hy Hic general account of Nationw�de. If the Applic:uit elected the Fised Account,one of the exchange restrictions options listed below must be elected. ❑ Contract Levcl A��reonte ExcL�nae Limitnfion(the limitation on Otd�uint;Eschanges from the Fixed Account is detennined based on total assets hcld in the Co tract's Fixed Account as a percentage of the Fixed Accounfs value under the Contract as of'Uie last Business Day preceding the current calendar year). �articiaant I,evel Exchanoe l.imit�tioo(the limitation on Outgoing Exchanges from Ihe Fixed Account is applied ro each Yarticipant Accuunt w�der the Contract. "�he Contract Owner,or its desi�mated Record Keeper is responsible for applying this limitation). NIu1-010=4A0 I/�FI�(3001-Standard)(9/?007)