Ill. Admin. Code tit. 50, pt. 917, exh. B - Notice Regarding Proposed Replacement of Life Insurance or Annuity

(Name of Existing Insurer)

(Address)

(City, State, Zip Code )

(Salutation)

You are herewith given notice that we are in receipt of application(s) for life insurance or annuity(ies) for an individual presently insured with your company.

Identification

Name of Insured	_____________________
Address	_____________________
_____________________
Contract Number	_____________________	_____________________
" "	_____________________	_____________________
" "	_____________________	_____________________
" "	_____________________	_____________________

This notice is given pursuant to 50 Ill. Adm. Code 917.70(c)

____________________________	____________________________
(Insurance Producer's Signature)	(Closure)

Notes

Ill. Admin. Code tit. 50, pt. 917, exh. B