Contact Info

For Advisors:

(866) 667-0564

For Clients:

(866) 667-0561

Media Relations:

Deborah Newman
(212) 220-5862

Fax:

(866) 667-0563

New Business Address:

PO Box 36750
Louisville, KY 40223

Payment Processing/

Client Service Address:
PO Box 36840
Louisville, KY 40233

Delivery/Express Address:

9920 Corporate Campus Dr
Suite 1000
Louisville, KY 40223

Corporate Office:

435 Hudson Street
New York, NY 10014
p: 212.741.9311
service@jeffnat.com

A flat fee of $20 a month is unheard of...Over time, this is a huge advantage.
—Chicago Tribune, February 2006

Monument Advisor Electronic Application Wizard

With this flexible application wizard you may choose to fill out an application online, then print, sign and mail it. Or you may download an application kit to your desktop, complete it, print, sign and mail, or we'll mail an application kit to you.

I would like to receive my application by:*
Completing an Application On-line.
Downloading an Application Kit.
Having an Application Kit mailed to me.

If you are an Advisor, you must log in to the Advisor (MAX) site to access the financial professional application kit. Click here to log in (or register for the Advisor site), and then return to this page.

Access your saved electronic application.

Contact Information

Are you:*
A consumer?
Representing your client as an Advisor?

Application State:*

First Name:*

Last Name:*

Company/Firm Name:*

Street Address:*

City:*

State:*

Zip:*

Phone:*

E-mail:*

Please allow five to seven business days for your kit to arrive. Monument Advisor is not available in NY. Monument Advisor must be sold by a registered representative affiliated with a broker-dealer in the states of FL and NC.

If you are representing your client as a Registered Representative, your Broker/Dealer must have a Selling Group Agreement with Jefferson National, and you must be appointed with Jefferson National to sell variable annuities in the Application State selected to be able to sell this product.

*Indicates required field.

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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 #: jef-requestakit-20090501