Jackson National Life Insurance Company

Jackson National Life Insurance Company PO Box 305153, Nashville TN 37230-5153 Phone 800.437.8854 Fax 803-333-7879 Visit us %/DARREN K INDYKE PLLC 575 LEXINGTON AVENUE FLOOR #4 NEW YORK NY 10022 Policy /glue $5,o0D,Dov POLICY NO. JAC KS ON® NATIONAL LIFE INSURANCE COMPANY PAYMENT NOTICE "10./. 2oi t•liegsr INSURED DUE DATE DESCRIPTION AMOUNT VIL0004735 JEFFREY E EPSTEIN 11/19/17 ANNUAL PREMIUM DUE IMPORTANT INFORMATION: Paying by check authorizes Jackson National Life Insurance Company to send the information from your check electronically to your bank for payment. Your account will be debited in the amount of your check and the transaction will appear on your bank statement. You will not receive your cancelled check back. II we cannot post the transaction electronically, you authorize us to present a copy of your check for payment. Payment must be received by the duo date shown above or your policy will enter its grace period and will terminate if the renewal premium is not received by the last day of the grace period, unless your policy has a net cash value and provides for and coverage continues under any of the following: 1) a nonforfeiture option, 21 an option to discontinue premium payments, or 31 an automatic premium loan election. Common nonforfeiture options are the purchase of extended term insurance, the purchase of reduced paid-up insurance or you may surrender your policy for the net cash value. Refer to your policy for time limits and options available. $9,382.40 AMOUNT DUE $9,382.40 v /9 20/6 ptitc e)08-s o2 ca4, P}o ,N sviee . Q 9, or 9:3- 6-bwittied. Domito t/ if/a Nov 2o16 I o.s 37S- .1\1AI 202t0/471/ 27s- 2oo( Ile, qZS Noy 20 zo 4/28,323- RETAIN THIS PORTION FOR YOUR RECORDS RETURN THIS PORTION WITH YOUR PAYMENT POLICY NUMBER INSURED'S NAME VILD004735 JEFFREY E EPSTEIN MAKE CHECK PAYABLE TO Jackson National Life Insurance Company Making multiple full payments. Mailing address change indicated on back. Enclose your payment with this coupon and send to: Jackson National Life Insurance Company PO Box 371425 Pittsburgh, PA 15250-7425 Amount Due on 11/19/17 $9,382.40 Premium Payment $9,382.40 s, Less Premium Reduction $0 00 Pf Loan Repayment moo $ Tote/ Amount Due $9,382.40 $ Additional Payment $ Total Amount Enclosed 35250913014303031437333500000000000011191712009382401735500938240000000009 EFTA00811572