Agent Do Good Award Nomination Form Nomination period is February 1 - April 1, 2024 Please complete all the information below explaining, in as much detail as possible, how the agent has made a difference. The most complete and impactful nominations will be considered for the award.We look forward to learning more about the Agent’s cause. Question Title * 1. Agent's First Name: Question Title * 2. Agent's Last Name: Question Title * 3. Agent's Email: Question Title * 4. What is the specific focus of the agent’s cause? (For example, animal welfare, hunger relief, autism awareness, etc.) Question Title * 5. How does the agent support this Cause, other than making financial donations? (Please tell us the story, provide as much detail as possible.) Question Title * 6. Provide the name of the Nonprofit Organization the Agent works with to Impact This Cause? (If selected, this is the organization that will receive the award. It must also be a 501(c)(3) non-profit organization that is not a religious, labor or fraternal group and must not discriminate in any way on the basis of race, religion, gender, age, national origin, disability or sexual orientation.) Question Title * 7. Your Name: Question Title * 8. Your Email: Thank you for taking the time to nominate your National Life Agent!And, thank you for being a part the of National Life Group family. Note that we will apply the following criteria to determine if agents are eligible: The agent must have at least two full years of service, be in good standing and actively writing business with the National Life Group. (Career agents must have full-time status) Nominees have been supporting their cause for at least one year. The agent’s time and effort to their cause are making a difference and positively impacting their community and the lives of others. Their cause is a 501(c)(3) non-profit organization that is not a religious, labor, or fraternal group. The organization must not discriminate in any way on the basis of race, religion, gender, age, national origin, disability, or sexual orientation. An agent can only win once in a five-year period. Agent causes can be domestic or international. If you have any questions about the Agent Do Good Award, please send to: giving@nationallife.com National Life Group® is a trade name of National Life Insurance Company, Montpelier, VT, Life Insurance Company of the Southwest, Addison, TX and their affiliates. Each company of National Life Group is solely responsible for its own financial condition and contractual obligations. Life Insurance Company of the Southwest is not an authorized insurer in New York and does not conduct insurance business in New York. TC139171(0124)3 Done