Application – Single Premium Deferred Annuity

Non-State Specific Forms:

• 1035 Exchange / Rollover / Transfer
• Annuity Contract Disclosure
• Direct Deposit Authorization
• Power of Attorney
• Replacement of Life Insurance or Annuities
• Suitability:
  • Consumer Refusal to Provide Information
  • Consumer Decision to Purchase an Annuity NOT Based on a Recommendation
  • Insurance Agent Disclosure
  • Questionnaire
• Certification of Trust and Trustee Powers

Arkansas

• Important Notice
• Limitations and Exclusions Under the Arkansas Life and Health Insurance Guaranty Association Act
• Agent’s Certification as to the Validity of Power of Attorney and Agent’s Authority

Georgia

• Important Notice: Replacement of Life Insurance or Annuities

Indiana

• Notice to Indiana Contract Owners
• Notice of Protection Provided by the Indiana Life and Health Insurance Guaranty Association
• Notice of Replacement of Life Insurance or Annuities

Louisiana

• Receipt and Acknowledgement of Delivery
• Summary of the Louisiana Life and Health Insurance Guaranty Association Act and Notice Concerning Coverage Limitations and Exclusions

Missouri

• Notice of Protection Provided by Missouri Life and Health Insurance Guaranty Association

Mississippi

• Notice of Protection Provided by Mississippi Life and Health Insurance Guaranty Association

Tennessee

• Tennessee Contract Owners Service Information
• Notice Concerning Coverage Under the Tennessee Life and Health Insurance Guaranty Association Act
• Notice of Replacement of Life Insurance or Annuities

Texas

• Texas Notice
• How you’re protected if your life or health insurance company fails