SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM N-8A
The undersigned investment company hereby notifies the Securities and Exchange
Commission that it registers under and pursuant to the provisions of Section
8(a) of the Investment Company Act of 1940 and in connection with such
notification of registration submits the following information:
Item 1. Name:
Jackson National Separate Account IV
Address of Principal Business Office:
5901 Executive Drive, Lansing, Michigan 48911
Telephone Number (including area code):
(517) 394-3400
Name and address of agent for service of process:
Thomas J. Meyer,. Esq.
5901 Executive Drive
Lansing, Michigan 48911
Check appropriate box:
Registrant is filing a Registration Statement pursuant to Section 8(b) of the
Investment Company Act of 1940 concurrently with the filing of Form N-8A:
Yes No: X
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Items 1 & 2 . Jackson National Separate Account IV (the "Separate Account") was
organized under the insurance laws of the State of Michigan on December 16,
1997.
Item 3. The Separate Account is a segregated asset account of Jackson National
Life Insurance Company.
Item 4. It will be registered as a unit investment trust under the Investment
Company Act of 1940, as amended.
Item 5. a. Not applicable.
b. Not applicable.
Item 6 Not applicable.
Item 7. Not applicable.
Item 8.
a. Jackson National Life Insurance Company, 5901 Executive Drive
Lansing, Michigan 48911, is the sponsor/depositor of the
Separate Account
b. Officers and Directors of the Sponsor:
Jonathan Bloomer Director
Robert P. Saltzman President & Chief Executive Officer and Director
Clark P. Manning Chief Operating Officer and Director
Andrew B. Hopping Executive Vice President & Chief Financial Officer
and Director
Victor Gallo Senior Vice President - Group Pension
William A. Gray Senior Vice President - Product Development &
Special Markets
Alan C. Hahn Senior Vice President - Marketing
Brion S. Johnson Senior Vice President - Financial Operations and
Treasurer
David LeRoux Senior Vice President - Group Pension
Thomas J. Meyer Senior Vice President, General Counsel & Secretary
J. George Napoles Senior Vice President & Chief Information Officer
Scott L. Stolz Senior Vice President - Administration
John B. Banez Vice President - Systems and Programming
Gerald W. Decius Vice President - Systems Model Office
Lisa C. Drake, FSA, MAAA Vice President & Actuary
James D.Garrison Vice President - Tax
Joseph D. Emanuel Vice President & Associate General Counsel
Robert A. Fritts, CPA Vice President & Controller - Financial Operations
Rhonda K. Grant Vice President - Government Relations
Wyvetter A. Holcomb Vice President - Telephone Service Center
Stephen A. Hrapkiewicz, Jr. Vice President - Human Resources
Timo P. Kokko Vice President - Support Services
Everett W. Kunzelman Vice President - Underwriting
Lynn W. Lopes Vice President - Group Pension
Keith R. Moore Vice President - Technology
Jacky Morin Vice President - Group Pension (effective 4/3/00)
P. Chad Myers Vice President - Asset Liability Management
Mark D. Nerud Vice President - Fund Accounting and Administration
John O. Norton Vice President - Actuary & Appointed Actuary
Bradley J. Powell Vice President - Institutional Marketing Group
James B. Quinn Vice President - Broker Management
Robert M. Tucker Vice President - Technical Support
Connie J. (Dalton)
Van Doorn Vice President - Variable Annuity Administration
o The business address of each officer and director is 5901
Executive Drive Lansing, Michigan 48911
c. The Separate Account does not currently have a Custodian.
Item. 9.a. The Separate Account is not currently issuing securities.
Item 9.b. Not applicable.
Item 9.c The Separate Account proposes to make a public offering of
its securities upon effectiveness of its registration
statement under the Securities Act of 1933.
Item 9.d. The Separate Account does not have any securities
currently outstanding.
Item 9.e. Not applicable.
Item 10. The Separate Account does not currently have any assets.
Item 11. The Separate Account will not operate as a small business
investment company.
Item 12. Not applicable.
Pursuant to the requirements of the Investment Company Act of 1940, the
Registrant has caused this notification of registration to be duly signed on its
behalf, in the City of Lansing, and the State of Michigan, on the 8th day of
May, 2000.
(seal) Signature: Jackson National Separate Account IV
(Name of Registrant)
By: Jackson National Life Insurance Company
(Name of sponsor)
By: /s/ Andrew B. Hopping
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Andrew B. Hopping
Executive Vice President, Chief
Financial Officer and Director
Attest: /s/ Thomas J. Meyer
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Thomas J. Meyer
Senior Vice President, Secretary and General Counsel
