Common use of INSURANCE HISTORY Clause in Contracts

INSURANCE HISTORY. 1. Do you have any existing life insurance or annuities? o Yes o No 2. Will this insurance replace* any existing insurance or annuity? o Yes o No 3. List the following details for all existing coverage. (List all in force life insurance; only annuities to be replaced): Insurance Company Face Amount Type Product To Be Replaced?* 1035 Exchange? a. $ If Replacement, policy number : b. $ If Replacement, policy number :

INSURANCE HISTORY. 1. Do you have any existing life insurance or annuities? Note: Existing coverage includes any life insurance policies that have been assigned, sold or transferred. o Yes o No 2. Will this insurance replace* any existing insurance or annuity? o Yes o No 3annuity?3. List the following details for all existing coverage. (List only annuities to be replaced*, list all in force life insurance; only annuities to be replaced.): o Yes o No Insurance Company Face Amount Type Product To Be Replaced?* 1035 Exchange? a. $ If Replacement, policy number : b. $ If Replacement, policy number :

INSURANCE HISTORY. 1. Do you have any existing life insurance or annuities? o Yes o No 2. Will this insurance replace* any existing insurance or annuity? o Yes o No 3. List the following details for all existing coverage. (List only annuities to be replaced*, list all in force life insurance; only annuities to be replaced.): Insurance Company Face Amount Type Product To Be Replaced?* 1035 Exchange? a. $ If Replacement, policy number : b. $ If Replacement, policy number :

INSURANCE HISTORY. 1. Do you have any existing life insurance or annuities? o Note: Existing coverage includes any life insurance policies that have been assigned, sold or transferred. Yes o No 2. Will this insurance replace* any existing insurance or annuity? o Yes o No 3. List the following details for all existing coverage. (List all in force life insurance; only annuities to be replaced): Insurance Company Face Amount Type Product To Be Replaced?* 1035 Exchange? a. $ If Replacement, policy number : Group Annuity Yes Individual Life No No b. $ If Replacement, policy number :Group Annuity Life Yes No

INSURANCE HISTORY. 1. Do you have any existing life insurance or annuities? o  Yes o  No 2. Will this insurance replace* any existing insurance or annuity? o  Yes o  No 3. List the following details for all existing coverage. (List only annuities to be replaced*, list all in force life insurance; only annuities to be replaced.): Insurance Company Face Amount Type Product To Be Replaced?* 1035 Exchange? a. $ If Replacement, policy number : b. $ If Replacement, policy number :