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Lincoln Account Application
Instructions
Click on the link at the end of these instructions for a PDF of the Lincoln account application. Complete it and print for a physical signature. You will find several sections of the Lincoln application that should be left blank. Your Lincoln representative will complete these once the Plan Administrator has submitted your completed application to establish your new account.
Send the completed and signed application to your campus Benefits Administrator and keep a copy of the application for your personal files. Contact Lincoln directly with questions about the application, or their investments and services.
Section 1: Annuitant
Complete this section with your personal information.
Section 2: Employer/Remitter
Please complete this section in this manner:
- 1. The "Remitter Name" is "MA Department of Higher Education" and your campus (e.g., Salem State College, UMass Boston, etc)
- Your "Remitter Number" is either:
- all state and community colleges: CR26844
- all University of Massachusetts campuses: CR26842
Section 3: Suitability
Leave this section blank. The Lincoln Representative will complete it after discussing investment selections with you.
Section 4: Allocation of Contributions
Complete this section, identifying the percentage of Plan Contributions to invest in the selected funds. The total of the percentage allocation must be 100%. This allocation may be changed at any time directly with Lincoln.
Section 5: Telephone Authorization Agreement
Select either "Yes" or "No". Selecting "Yes" will provide access to the Lincoln account by telephone.
Section 6: Beneficiary Designation
Provide the required information about the beneficiaries for your ORP account at Lincoln. These designations may be changed at any time directly with Lincoln.
Section 7: Contribution
Leave this section blank.
Section 8: Additional Remarks
Leave this section blank.
Section 9: Replacement
Select "No" if enrolling in the ORP for the first time. Select "Yes" if you are already enrolled in the ORP and changing from one of the other Providers to Lincoln. Please include the name of the previous ORP Provider and account number at that firm. Do not complete the sections about "Type of Existing Contract."
Section 10: Declarations and Signatures
Please read this section carefully, then sign as the "Annuitant" if you agree to these conditions. "For ERISA Plans": Leave this section blank
Section 11: Representative’s Report
Leave this section blank.
Customer Identification
Leave this form blank.
Application for Individual Deferred Annuity (.PDF)
Related Links
Lincoln Financial Group
