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 |
_____________________ |
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Address |
_____________________ |
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_____________________ |
||
Contract Number |
_____________________ |
_____________________ |
" " |
_____________________ |
_____________________ |
" " |
_____________________ |
_____________________ |
" " |
_____________________ |
_____________________ |
This notice is given pursuant to 50 Ill. Adm. Code 917.70(c)
____________________________ |
____________________________ |
(Insurance Producer's Signature) |
(Closure) |
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