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  • I(JSttR..ed /-JA5 Ex; s i-,n, Li{:e .TI1S.

    104- is

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    MA5120 (0€'1

    6. LIFE INSURANCE IN FORCE AND REPLACEMENT INFORMATION Yes No ~~~-----------------------=~~~

    a. Does any Proposed Insured have life insurance or annuity appiications pending withother companies? " .. ... . ." ..... "". " " .... . ".. 0 JLJ b. Is there any existing life insurance or annuity coverage on the life of any Proposed Insured? "" " "'""",,''''' " "." "" ., ". " JZf

    (If Yes, provide information below and complete the applicable replacement form(s) and submit wllh application Application and replacement form(s)

    must be dated on the same date) c. Will the li fe insurance applied for replace, or otherNise reduce in value, any existing life insurance or annuity now in force? . 0 d. Is this an intemal replacement? (If Yes, include a Surrender form or Absolute ASSignment form for the life insurance or annuity being replaced.) ... 0 e. If current life insurance or annuity is being replaced, Indicate the amo nt of surrender charges that wi ll be assessed. ".""".. "" .. "." S

    Insured's Name C Owner A t AccidentalI (Last First MI) ompany " moun Death Benefit

    7. OWNER INFORMATION a. Relationship to Proposeo Insured c. SSN or Taxpayer 10

    d. Address (Include City. State, and ZIP. If mailing address is a PO Box a street address is also require d)

    e. How long at current address? ___ ._ If less than 5 years at current address. prior address is required.

    f. Home Phone g. Work Phone Date of Birth (MMIOOIYYYY) Place of Birth (City. State. Country)

    _8_._ PAYOR INFORMATION (If different from the Proposed Insured and Owner. a. Payor's Name (Last, First. MI) b. Relationship to Proposed Insured c. SSN or Taxpayer 10

    d. Address (Include City. State, and ZIP. If mailing address is a PO Box. a street address is also required.)

    e. How long at current address? ___ If less than Syears at current address. prior address is required.

    9. SPECIAL REQUESTS

    Additional Proposed ProposedPERSONAL HISTORY (Provide details of all 'Yes" answers in the Personal His/ory Details section below.) Insured Insured Yes No, Yes No

    10. Has any Proposed Insured ever been declined, rated,or modified for life or health insurance? . ". " ,, " . "".O)if o D 11. Within the past tvvo (2) years, has any Proposed Insured.

    a made any ftights as apilot. stude t pilot. or memberof a fi ight crew? (If Yes, complete aviation questionnaire.) .. ...".0 ;zr o 0 b. engaged In the fo llOWing hazardo s sports: bungee or base Jumping. parachuting, hang glioing. competitive skIIng/snowboarding

    (such as heli-skiing or ski Jumping); diving activities (such as scuba. cave diving, or underwater photography); canyoning, kayaking, or white water rafting; organized racing (such as automobiles, drag racers, or motorcycles); rock or mountainclimbing. r7'1" rodeo riding. or any other hazardous sportlactivity'j (If Yes, complete sports questionnaire.) ..."" .". ",,0 ? 0 0

    12. Within the past seven (7) years, has any Proposed Insured been convicted or, pleaded guilty to, or entered a plea of no contest to

    ~; . r~:~:~:;e~:;(~);~e~~;;!s~;:~~:::E~:,,~~:~i~j::~i~i::~:~~:~~;~~~i;~le~:~~i~~te; .f;,~;te •••·•· ••·•• · ·~ D B than thirty (30) days? (If Yes where? Provide details below.)"... ..0~ 0 0

    15. \i\~thin the past five (5) years. has any Proposed Insured a. pleaded guilty to or been convicted of three (3) or more moving violations? .. ... . . .. . .. .....o~ 0 0 b. had a driver's license suspended or revoked. or are you currentiyunder license suspension or revocation? .... .. . . . ......... 0 0 0

    c. been convicted of reckless driving or driving under the inftuence of alcohol or drugs? .. .." .. . ...... .0 0 0

    16. Driver's License ~Jumber(s) during the past five (5) years Name of Proposed Insured(s) on Drivers License Driver's License Number State Issued

    x» PERSONAL HISTORY DETAILS Question # Proposed Insured's Name Dates

    - t--- -

    Details

    Americo Financial lJie and AnnUity Insura ce Company • Horne ff~e: Dallas. -exa5 . Admlrtslrative Office: POBOX 410288. Kansas ~i\y . 1.1064 ' 41-0288 :,00' .'I. america com AAA5120 (06111) Page 2 of 4

  • Important Notice:

    Replacement of Life Insurance or Annuities AAAB327 (2008j AIWESlco

    Important Note· This document must be signed by the applicant and the agent, if there is one, and a copy left with the

    applicant, Application and Replacement Notice must be signed on the same date,

    You are conte mplating the purchase of a life Insurance policy or annuity con tract. In some cases this pu rchase may involve discon tir,~ i:lg or chan gi ng an existing policy or contract. If so, a replacement is occurring. Financed purchases are also considered replacements.

    A replacement occurs when a new pol icy or contract is purchased and. in connection wi th the sale, you discontinue making premium payments on an existing policy or contract, or an existing policy or contract is surrendered, forfeited, assigned to the replacing insurer, or othenNise terminated or used in a financed purchase.

    A financed purchase occurs when the purchase of a new life insurance policy involves the use of funds obtained by the withdrawal or surrender of or by borrowing some or all of the policy values, including accumulated dividends, of an ex isting pol icy to pay all or part of any premium or pa yment due on the new policy A financed purchase is a replacement.

    You should carefully consider whether a replacement IS in your best interest. You will pay acquisition costs and there may be surrender costs deducted from your pol icy or contract. You may be able to make chJngcs to your existing policy O~ contract to meet your insurance needs at less cost. A fina nced purchas e will reduce the va lue of your existing policy or contract and may reduce the amount pa id upon the death of the insured .

    We want you to understand the effects of replacements before you make your purchase decision and ask that you answer the following questions and consider the questions on the back of this fomn.

    1. ~r~~~~tj~~n~~~~r~nx1S~i. i~~0;~:~~i~; :~~;~~t ~r~~iu.~ pay~ents ,. s~~en.der. ing .fo~eitin~ : . ~~~ignin~. t~ .thein~~r~r . o.rothe.~i~~ ........... .0 ye2,;~ 0 2. Are you considering using funds from your existi ng policies or contracts to pay premiums due on the new policy or contract? ..... .... 0 Ye S ~NO

    If you answered ''Yes'' to either of the above questions, list each existing polivY or contract you are contemplating replacing (including the na e of the insurer. the insured or annuitant, and the policy or contract number if avai lable) and whether each policy or contract will be replaced or used as a source of financin

    1 . 2. 3.

    Insurer Name Contract or Policy # Insured or Annuitant

    Make sure you know the facts. Contact your existing company or its agent for information about the old policy or contract. If you request one , an in fo rce ill ustration. policy summary or available disclosure documents must be sen t to you by the existing insurer. Ask for and retain all sales material used by the agent in the sales presentation Be sure that you are making an informed decision.

    The existing policy or contract is being replaced beca use:

    best of my knowledge, acc rate

    &.ed ~/;etl± Applicant's Printed ame Oat

    J)aviJ otPIO(g /:1{JL '? Oatt r -Agent's Printed Name

    I do not want this notice read alou d to m Applica nts must i ilial only if th ey do not wan t the notice read aloud.)

    SALES MA TERIAL CERTIFICATION

    o I certify that I used the following company-approved and/or irCPIidualized marketing materials. including any electronically prese nted materials. in my presentation (list form numbers below).

    I certify that I did not use any marketing materials in my presentation .

    By signing below. I certify that the information above is correct and that I left copies of all sales materials used in my presentation with the appli can t,

    Agent' ignature :DAliid ~. Afft!.,tt

    Agent' s Prin ted Name

    Important Note: Application and replacement notice must be signed on the same date. Arne 'co Financial Llieand nuity Insura r.ce Compan ' Home O'ice Dallas, Texas A.dmlrislrallve Office PO BOX 410283. Ka sas City , MO 64 '41-{)288 \w ( ,'; amenca.com

    AAA8327 1200 8) 15t Copy - Ad I strative Office 2nd Copy - Apphcant 3rd Copy - Agent

    http:amenca.comhttp:Insurar.ce

  • Replacement Appropriateness

    Agent Verification Form IIMER;co12·, 08·1 \1,112) This form must be completed and submitted when replacing an existing policy or contract in the following states: AK, AL, Al, AR, CO, HI, lA, KY, LA, ME, MD, MT, NE, NH, NJ, NM, NC, OH, OR, RI, SC, SD, TX, UT, VA, WV, WI. See Americo.com for state updates.

    A erlce Fina cial Life and Annuity In urance Company regularly advises appointed agents of the need to fully evaluate replacement recommendati ons. Replacements should only occur when it is in :l1e clien ·s best interest and when the client fully understands both the benefits and any disadvantage of the product change America expects each agent pro asing a replacement to evaluate tne appropriateness of the replacement according to the following guideli es , an any other factors releval t at the time of the sale . For eacn replacement, the preduct replacing a existing policy or contracl must meet the client's needs and objectives, the agent must fully explain the product, including a discussion of the adva tages and disadvantage of replacemeni, all state required re placement disclosures must be read aloud. wee required, andlor reI iewed and forms ampleted by the client a d agent. and sales aterial s used to explain the prooue: or justify the replacement must be left with the client Clients have the right to make an Informed deCIS ion regarding replace ents. Tile agent s 'ole in a replacement sale is to make sur", the cli.s It is armed with the Information he/she need .

    As an agent. you ust also consider a y alternatlves 0 replacement that may meet your client's needs. You should present your cl ient Wit" all options to weigh aga inst the re lacemen of his/her existing product. For example, the client may be able to update an existing policy to pro Ide better cash value growth . The client may also benefit from keeping the existing policy and purchasing another product to fill In or additional n eed~ . Determine I the client qualifies for a rating re-classification. which could lower his/her premiums In some cases. co sldering an alterna ive ay still I eel the de'inition of a replace en. but would ultimately be a better solution fOi t e cl ient Instead of lapsing an existing produ t for another.

    By signing below. you confirm that you have discusse the following factors, where applicable With each customer prior to completing a sa le involving he replacement f an existing policy or contra t:

    • Reducion of current cash value due to new acquisition cos ts • Le gth of lime needed to recover the costs assocla.ed With [he proposed pol icy or annuiiy contract • Tax impliC

    Agent Verification I hereby certify that in proposing t e replacement to the client. I haVE reviewed each of the above 'actors and other considerations with said clien t and discussed all advantages an disadvantages 0 the proposed replacemen t. I am submitting all ra uired state rep/acemen forms. and confi rm that each form has been reviewed 'lith the client and answered trL thfully. I have determined and confirmed with the client that the existing policy or contract no longer ,eets their needs and objectives and that the proposed replaceme t is appropriate in accordance

    ith this Replacement Appropriateness - Agent Verification and sta te law. I 1ave left copies of the company-approved advertiSing with the clien and have also Identified t e materials I used on the relevant replacement forms.

    Agent's Name Agent's Sig ture

    Proposed Insured/Annuitant:

    Americo FiraJ1cial life andAnnuity Irsurance Company , Home O·'ce Dallas Texas ' Admi .Istrabve Of.ice PO BOX 410288. Kansas City, MO 64 141.0288 • 'INN .amenco com 12·108 -1 (11/12)

    http:assocla.edhttp:Americo.com

  • A replacement may not be in your best interest. or your decision could be a good one. You should make a careful comparison of the costs and benefits of your existing policy or contract and the proposed policy or contract 0 e way to do th is is to ask the company or agent that sold you your existing policy or contract to provide you with information concerning your existing policy or contract This may include an illustration of how your existing policy or contract is working now and how It would perform in the future based on certain assumptions. Il lustrations should not, however, be used as a sale basis to compare policies or contracts . You shocld di scuss the followi ng with your agent to determine whether replacement or financing your purchase makes sense:

    PREMIUMS: Are they affordable?

    Could they change?

    You're older - are the premiums higher for the proposed new pOlicy?

    How long will you have to pay premiums on the new policy? On the old policy?

    POLICY VALUES: New policies usually take longer to bUild cash values and to pay dividends.

    Acquisition costs for the old policy may have been paid: you will incur costs for the new one.

    What surrender charges do the policies have?

    What expense and sales charges wi ll you pay on the new pol icy?

    Does the new policy provide more insurance coverage?

    INSURABILITY: If your health has changed since you bought your old policy , the new one could cost you more, or you could be turned down.

    You may need a medical exam for a new policy.

    Claims on most new policies for up to the first two years can be denied based on inaccurate statements. Suicide limitations may begin are·... on the new coverage.

    IF YOU ARE KEEPING THE OLD POLICY AS WELL AS THE NEW POLICY: How are premiums for both policies being paid?

    How will the premiums on your existing policy be affected?

    Will a loan be deducted from death benefi ts?

    What values from the old policy are being used to pay premiums?

    IF YOU ARE SURRENDERING AN ANNUITY OR INTEREST SENSITIVE LIFE PRODUCT: Will you pay surrender charges on your old contract?

    What are the interest rate guarantees for the new contract?

    Have you compared the contract charges or other policy expenses?

    OTHER ISSUES TO CONSIDER FOR ALL TRANSACTIONS: What are the tax consequences of buying the new pol icy? Is this a tax free eXChange? (See your tax advisor. )

    Is there a benefit from favorable "grand-fathered" treatment of the old policy under the federal tax code?

    Will the existing insurer be will ing to mOdify the old policy? How does the quality and financial stability of the new company compare wi th your existing company?

  • r IIS/,fle.J J./A ~ £)(;~+/, Life .rIlS£tR4nce.

  • M4.5 ' 20 {06i l °)

    6. LIFE INSURANCE IN FORCE AND REPLACEMENT INFORMATION Yes No a. Does any Proposed Insured have life insurance or annuity applications pending with other companies? 0 b. Is there any existing life insurance or annuity coverage on the li fe of ary Proposed Insured? .. . . .. :.::.: ..:.:::.:.:: .:.. ~ 0

    (If Yes, provide information belo~v and complete the applicable replacement formes) and submit with application. Application and replacement formes) must be dated on the same date)

    c. Will the life insurance applied for replace, or otherwise reduce in value.any existing life insurance or annuity now in force? .. ............... .. ..;@ 0

    d. Is this an intemal replacement? (If Yes: include a Surrender form or Absolute Assignment form for the life insurance or annufty being replaced) 0 Jlf e. If current life Insurance or annuity IS being replaced, Indicate the amount of surrender charges that will be assessed. ......... ........... ........ ... S

    Insured's Name Accidental (M DO

    Policy Date (Last. First. MI) Company Owner Amount Death Benefit

    ::r. ---

    7. OWN ER INFORMATION (If different from the Proposed Insured. l a. Owner's Name (Last. First, MI) b. Relationship to Proposed Insured c. SSN or Taxpayer 10

    d. Address (Include City. State, and ZIP. If mailing address is a PO Box. a street address is also required.)

    e. How long at current address? _ __ If less than 5years at current address, prior address is required.

    f. Home Phone g. Work Phone h. Date of Birth (MMIOO!YYYY) Place of Birth (City, State. Country)

    8. PAYOR INFORMATION (If different from the Pro osed Insured and Owner ) a. Payor's Name (Last. First. MI) b. Relationship to Proposed Insured c. SSN or Taxpayer 10

    d. Address (Include City State, and ZIP. If mailing address is a PO Box. a street address is also required.)

    e. How long at current address? ___ If less than 5years at current address, prior address is required.

    9. SPECIAL REQUESTS

    Additional Proposed ProposedPERSONAL HISTORY (Provide details of all "Yes ' answers in the Personal History Details section below) Insured Insured Yes No, Yes No

    10. Has any Proposed Insured ever been declined, rated. or modified for life or hea~h insurance? . .. ....... 0 JZ o 0

    11 . With in the past two (2) 'leans, has any Proposed Insured d

    a. made any fiights as a pilot. student pilot, or member of a fiight crew? (If Yes, complete aviation questionnaire.) ...... ..... .......... 0 / o 0

    b. engaged in the following hazardous sports: bungee or base jumping, parachuting. hang gliding; competitive skiinglsnowboarding

    (such as heli-skiing or ski jumping); diving activities (such as scuba, cave diving, or underwater photography); canyoning, kayaking, orwhite water rafting; organized racing (such as automobiles, drag racers,or motorcycles): rock or mountain dimbing d rodeo ridw;g, or any other hazardous sportlactivity? (If Yes, complete sports questionnaire.) . ... .... 0 P o 0. HH

    12. :i~h;~!:n~st seven (7) years , has any Proposed Insured been convicted ~f,P I~~d.ed..gUilty to, or entered a plea of no contest to ...... .00 ~ o 0 13. Is any Proposed Insured currently on probation or been placed on probationwithin the last tvvelve (12) months? ........ ~ o 0

    14. vVithin the next t\VO (2) yeans, does any Proposed Insured intend te work, travel, or reside outside of the United States for more

    than thirty (30) days? (If Yes, where? Provide details below,) .... 0 ;z1 o 0 15. Within the past five (5) years. has any Proposed Insured

    a. pleaded guilty to or been convicted of three (3) or more moving violations? ..................... . ..... 0#o 0

    b. had adrivers license suspended or revoked. or are you currently under license suspension or revocation? ..... ......... ... . ... 0 o 0

    c. been convicted of reckless driving or driving under the infiuence of alcohol or drugs?..'0 o 0

    16 Driver's License Number(s) during the past five (5) years Name of Proposed Insured(s) on Drivers License Driver's License Number State Issued

    TX PERSONAL HISTORY DETAILS Question # Proposed Insured's Name Dates Details

    America Finanoalll!e and A nUl : IrlSurarce Compa~y Home Office: Oallas Texas ' Ad ,,,,strati e O'fice PO BOX4~028B , Kansa City. MO 641 1-0288 • ':.\w/.america com

    AAA5120 (06111) Page 2 of 4

    http:f,PI~~d.ed

  • Important Notice:

    Replacement of Life Insurance or Annuities AAA832 (2008) 4IWERico

    Important Note· This document must be signed by the applicant and the agent, if there is one, and a copy left with the applicant. Application and Replacement Notice must be signed on the same date,

    You are contemplating the purchase of a life insurance policy or annuity contract In some cases this purchase may involve discontinuing or changing an existing policy or contract. If so, a replacement is occurring. Financed purchases are also considered replacements.

    A replacement occurs when a new policy or contract is purchased and . in connection with the sale, you discontinue making premium payments on an existing policy or contract, or an existing policy or contract is surrendered , forfe ited . assigned to the re placing insurer, or otherwise terminated or used in a financed purchase .

    A financed purchase occu rs when the purchase of a new life insurance policy involves the use of funds obtained by the withdrawal or surrender of or by borrowing some or all of the policy values, including accumulated dividends, of an existing policy to pay all or part of any premium or payment due on the new policy. A fina nced purchase is a replacement.

    You should carefully consider whether a replacemen t is in your best interest. You will pay acquisition cos ts and there may be su rrender costs deducted from your pol icy or contract. You may be able to make changes to your existing policy or co tract to meet your insurance needs at less cost. A financed purchase will reduce the value of your existing policy or contract and may redu ce the amount paid upon the death of the insured.

    We '.vant you to understand the effects of replacements before you make your purchase decision and ask that you answer the following questions and consider the questions on the back of this form.

    1. Are you considering discontinuing making premium payments, surrendering, forfeiting, assigning to the Insurer, or other.'Iise terminating your existing policy or contract? ....... ... ............... ... .... ... ........ ... ....... .. .. ...... & Yes 0 0

    2. Are you considering using funds from your existing policies or contracts to pay premiums due on the new policy or contract? ......0 Yes JZNo you answered "Yes" to either of the above questions, iist each existing policy or contract you are contemplating replacing (including the name of the

    insurer. the insured or annui tant. and the policy or contract number if avai lable) and whether each policy or contract will be replaced or used as a sou rce

    1. 2.

    of fina ncin

    3.

    Make sure you know the facts. Contact your existing company or its agent for in formation about the old poli cy or contract. If you request one, an in force

    illustration. policy summary or available disclosure documents must be se t to you by the eXisting insurer. Ask for and retain all sales material used by the agent in the sales presentation . Be sure that you are making an informed decision.

    Th, ,,;sl;og pohcy" coNcoct ;s b" og "pl",d b'ca"",~ ~.;.

    Z;;; ~_ ~ ~ AHU t'.!2V~ W oro.i"""",,,P'Ir'!?>. the best of my knowledge, accurate

    &eel .::r: C,J,'eYl+ Applican s Signa

    Ageel's 5;9*,"¥ I do not wa is notice read aloud to m

    SALES MATERIAL CERTIFICATION

    o I ce rtify that I used the following company-approved and/or individualized marketing materials. inc! ding any electronically presented materials. in my presentation (list form numbers below).

    I certify that I did ot use any marketing materials :r my presentation

    By signing below. I certify that the information above is correct ar d that I left copies of ail sales materials used in my presentation with the applicant.

    Agent's Prin ted ame ~~kt3Oa e I

    Important Note: Application and replacement notice must be signed on the same date. Am2nco FinanclalU'e and Annuity Insurance Compan • Home Office Ollilas Te as Ailm, i:.rah·,e C Ice' PO BOX d10288. ansas City MO 6 141-0288 • www amenco com

    A.AA8327 (2008) 1st Copy - Administrative 0 , Ice Lnd Copy - Applicam 3rd Cop - Agent

  • Replacement Appropriateness

    Agent Verification Form 4MERico. 2· 108-1 [11i12) This form must be completed and submitted when replacing an existing policy or contract in the following states: AK, AL, Al, AR, CO, HI, lA, KY, LA, ME, MD, MT, NE, NH, NJ, NM, NC, OH, OR, RI, SC, SD, TX, UT, VA, WV, WI. See Americo.com for state updates.

    A enco Fina cia I Lif and Annuit Insurance Company regularly advises appointed agen s of the need to fully evaluate replacemen reco menoa Ions. R placements sho Id only occur w en It s In he ehe 's best interest and when the client 'ully unders tand both t e benefits and any disadvantages of the product change America expects each agen, proposing a replacement to evaluate t e appropriate ess of the replacement according to the following gUidelines, and any other factors relevant al the time of :he sale. For each replace ent, the product replacing a existing policy or contract must meet the client's needs and objectives, he agent must fully 6xplaln the pro 'uc:, including a discussion of the ad antages and disadvanta es of replacement. all state required replacement disclosures must be read aloud. where reqUired, and/or reI iewed and form completed by the client and agent a d sales material used 0 explain tne produci or justify the replacement must be left with the client. Clients have he right: make an informed decision regarding replacements. The agent' ro le II a replacement sale is to make sure the clilSllt i- aflllt:u ,\11th the ir,folll1at!on lie/she needs.

    As 81 agent. ~ ou must also consider any allernatl es 10 replacement tna! may meet your cl ient's needs, You should present your client With all options to weigh against the reolacement of hisiher eXls ing product. For example, the client may be aole to update an existing policy to provide better cash alue growth . The cl ient may also benefit from keeping the existing policy and purchasing another product to fill in for additional needs . Determine if the client qualifie for a rating re-classification which could lower his/her premiums In some cases, consideril 9 an alternative may sti ll meet the definition of a replacement. bu waul ultimately be a berter solution for the cl ient instead of lapsi'lg an existing product for another.

    By signing below. you con Irm that you have discussed the following factors, where applicable. with eac customer prior to completln~ a sale involving he replacement of an exisling policy or contract

    • Reductio of current cash value due .0 new acqUisition costs • Le gt of time needed to recover the costs associated With the proposed policy or annuity contract • Tax Implica ions discussed. if any. and cl ient advised to consult a professional tax or financial advisor • Impact on client's immediate liquid ity needs • Surrender charge schedule 0 11 existing and proposed pohcy or annuity contract • Pote iial i crease i cost of insurance due to Insured's Increased age or health at the time of replacement • Available riders and their associated costs/benefit • Fi a cial status of the eliem and retirement income needs • Circumstances under \ hich t e eXisting and pr posed policy could lapse • Du ration of coverage under the eXisting and proposed policy • Differences in features and benefits between the existing and proposed coverage or annuit contract • Differences in loan features between the eXisting a d proposed coverage or annuity ontract

    Agent Verification I hereby certify that In proposing the replacement to ,he client I ha e reviewed each of the above factors and other considerations With sai clie t and discussed ali ad anlages 31 d disadvantages of the proposed replaceme t I am submitting all required state replacemen forms, and nfirm that each form has been reviewed With the client a d answered tr thfully . I have determined and confirmed with the cl ient that the existing policy or contract no lange meets I eir needs a d objecUves. and that the proposed replacement is appropriate in accordance With t' is Replacement Appropriate ess . Agent Verificalion and state law I have left copies of the company-approved advertiSing 'lith the client a. d have also identified the ma erials I usee on the relevant replacement forms.

    Agent's Name .

    Proposed I nsuredlAnn u i tant:_-,-5 ~---.:;:r'llL!.f ~~....t.l-eg::leJ~ ~C)"""",,,r~Amenco Flnan C1al Life and AnnUIty Insurance Company • Home Office. Dallas. Texas • Adminis aliva Office; PO BOX d .0288, Kansas City, MO 6414 1-0288 • 'i NNi america com 12-108·1 (1 1112)

    http:Americo.com

  • A replacement may not be in your best interest. or your decis,o couln be a good one. You should make a careful comparison of the costs and benefits a your existing policy or contract and the proposed policy or contract. One way to do this is to ask the company or agent that sold you your ex isting policy or contract to provide you with information cancer ing yo r existing policy or contract. This may include an illustration of hOI your existing policy or contract is worki g now and how It would perform in the future based on certain assumptions. Il lustrations should no\, however, be used as a sale basis to compare policies or contracts. You should discuss the 'allowing with your agent to determine .whether replacement or financing your purchase makes sense .

    PREMIUMS: Are they affordable? Could they change?

    You're older· are the premiums higher for the proposed new poliCY?

    How long will you have to pay premiums on the new policy? On the old policy?

    POLICY VALUES: New policies us ally take longer to build cash alues and to pay diyi dend ~. Acquisition costs for the old policy may have been paid: you will incur costs for the new one. Vhat surrender charges do the policies have?

    What expense and sales charges wil l you pay on the new policy? Does the new policy provide more insurance coverage?

    INSURABILITY: If your health has changed since you bought your old policy. the new one could cost you more, or you could be tumed down.

    You may need a medical exam for a new policy. Claims on most new policies for up to the first tvvo years C2r cie deniec based C~ ir:accurate statements. Suicide limitations may begin anew on the new coverage.

    IF YOU ARE KEEPING THE OLD POLICY AS WELL AS THE NEW POLICY: How are premiums for both policies being paid?

    How will the premiums on your existing policy be affected? Will a loan be deducted from death benefits?

    What values from the old policy are being used to pay premiums?

    IF YOU ARE SURRENDERING AN ANNUITY OR INTEREST SENSITIVE LIFE PRODUCT: Will you pay surrender charges on your old contract? What are the interest rate guarantees for the new contract?

    Have you compared the contract charges or other policy expenses?

    OTHER ISSUES TO CONSIDER FOR ALL TRANSACTIONS: What are the tax consequences of buying the new policy? Is this a tax free exchange? (See your tax advisor.)

    Is there a benefit from favorable "grand-fathered ' treatment of the old policy nder the federal tax code?

    Will the existing insurer be willing to modify the old policy? How does the quality and financial stability of the new campa y compare with your existing company?

    In ", R.eJ ! it • I

    , •