Exhibit 99.5(a) LIBERTY LIFE ASSURANCE COMPANY OF BOSTON [contract#####] APPLICATION FOR MODIFIED SINGLE PAYMENT VARIABLE LIFE INSURANCE AND CONTRACT INFORMATION 1. Plan: / / Single Life / / Single Life W/Last Survivor Benefit 2. Initial Payment...Llac Variable Account • April 30th, 2004
Company FiledApril 30th, 2004
MAILING INSTRUCTIONS: Send this APPLICATIONS WITH PAYMENT (AND/OR ADDITIONAL APPLICATIONS WITHOUT PAYMENT: completed application as follows: PAYMENTS): REGULAR MAIL DELIVERY: Pacific Life Insurance REGULAR MAIL DELIVERY: Pacific Life Company,...Separate Account a of Pacific Life Insurance Co • December 7th, 2000
Company FiledDecember 7th, 2000
ADDITION OF THE KOPP EMERGING GROWTH FUND CLASS C SHARES TO THE TRANSFER AGENT SERVICING AGREEMENT Between KOPP FUNDS, INC. and FIRSTAR MUTUAL FUND SERVICES, LLC Dated October 1, 1997Kopp Funds Inc • December 30th, 1998
Company FiledDecember 30th, 1998WHEREAS, the above parties have entered into a Transfer Agent Servicing Agreement (the "Agreement") whereby Firstar Mutual Fund Services ("FMFS") has agreed to provide transfer agent services to Kopp Funds, Inc. (the "Corporation"); and
DSC COMMUNICATIONS CORPORATION PROXY CARD PROXY SOLICITED ON BEHALF OF THE BOARD OF DIRECTORS FOR THE SPECIAL MEETING OF STOCKHOLDERS TO BE HELD ON AUGUST 27, 1998 The undersigned hereby (a) acknowledges receipt of the Notice of Special Meeting of...Alcatel Alsthom /France • July 28th, 1998 • Telephone & telegraph apparatus
Company FiledJuly 28th, 1998 Industry
APPLICATION FOR CONSULTANT I AND II VARIABLE ANNUITY LINCOLN BENEFIT LIFE COMPANY, P.O. BOX 82532, LINCOLN, NE 68501-2532 ------------------------------- -------------------------------------------------------------------------------...Lincoln Benefit Life Variable Annuity Account • April 21st, 1998
Company FiledApril 21st, 1998
TYPE OF PLAN (PLEASE CHECK ONLY ONE BOX) PURCHASE PAYMENT ACCOUNT ALLOCATION -- ------------------------------------------------------------------------------- --------------------------------------------------- / / Non-Qualified $____________ / /...Minnesota Mutual Variable Annuity Account • April 14th, 1998
Company FiledApril 14th, 1998
INVESTMENT SUMMARY ------------------------------------------------------------ ------------------------------------------------------------------------ 1. Are you an employee of Minnesota Mutual or a subsidiary? / / Yes / / No 2. Are you a spouse or...Minnesota Mutual Variable Annuity Account • April 14th, 1998
Company FiledApril 14th, 1998
INVESTMENT SUMMARY ------------------------------------------------------------ ------------------------------------------------------------------------ 1. Are you an employee of Minnesota Mutual or a subsidiary? / / Yes / / No 2. Are you a spouse or...Minnesota Mutual Variable Annuity Account • April 14th, 1998
Company FiledApril 14th, 1998