3 CCR 702-4-1-4-A - IMPORTANT NOTICE: REPLACEMENT OF LIFE INSURANCE OR ANNUITIES

This document must be signed by the applicant and the producer, if there is one, and a copy left with the applicant.

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 the existing policy or contract, or an existing policy or contract is surrendered, forfeited, assigned to the replacing insurer, or otherwise 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 existing policy to pay all or part of any premium or payment due on the new policy. A financed purchase is a replacement.

You should carefully consider whether a replacement is in your best interests. You will pay acquisition costs and there may be surrender costs deducted from your policy or contract. You may be able to make changes to your existing policy or contract to meet your insurance needs at less cost. A financed purchase will reduce the value of your existing policy and may reduce the amount paid 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 form.

1. Are you considering discontinuing making premium payments, surrendering, forfeiting, assigning to the insurer, or otherwise terminating your existing policy or contract? ___YES___ NO

2. Are you considering using funds from your existing policies or contracts to pay premiums due on the new policy or contract? ___ YES ___ NO

If you answered "yes" to either of the above questions, list each existing policy or contract you are contemplating replacing (include the name of the insurer, the insured or annuitant, and the policy or contract number if available) and whether each policy or contract will be replaced or used as a source of financing:

INSURER NAME	CONTRACT OR POLICY #	INSURED OR ANNUITANT	REPLACED (R) OR FINANCING (F)
1.	_____________	______________	______________	______________
2.	_____________	______________	______________	______________
3.	_____________	______________	______________	______________

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-force illustration, policy summary or available disclosure documents must be sent 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 because _____________________________.

I certify that the responses herein are, to the best of my knowledge, accurate:

_______________________________________________ ______________

Applicant's Signature and Printed Name Date

_______________________________________________ ______________

Producer's Signature and Printed Name Date

I do not want this notice read aloud to me. _______

(Applicants must initial only if they do not want the notice read aloud.)

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.

One way to do this 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. Illustrations should not, however, be used as a sole basis to compare policies or contracts.

You should discuss the following with your agent to determine whether replacement or financing your purchase makes sense:

PREMIUMS:

* Are they affordable?

* Could they change?

* You're older-are 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 will 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 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 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 "grandfathered" treatment of the old policy under 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 company compare with your existing company?

Notes

3 CCR 702-4-1-4-A

37 CR 11, June 10, 2014, effective 7/1/2014 37 CR 12, June 25, 2014, effective 7/15/2014 Colorado Register, Vol 37, No. 14. July 25, 2014, effective 8/15/2014 37 CR 23, December 10, 2014, effective 1/1/2015 38 CR 03, February 10, 2015, effective 3/15/2015 38 CR 06, March 25, 2015, effective 4/30/2015 38 CR 09, May 10, 2015, effective 6/1/2015 38 CR 13, July 10, 2015, effective 7/30/2015 38 CR 19, October 10, 2015, effective 11/1/2015 38 CR 21, November 10, 2015, effective 1/1/2016 38 CR 23, December 10, 2015, effective 1/1/2016 39 CR 01, January 10, 2016, effective 2/1/2016 39 CR 05, March 10, 2016, effective 4/1/2016 39 CR 08, April 25, 2016, effective 5/15/2016 39 CR 19, October 10, 2016, effective 11/1/2016 39 CR 20, October 25, 2016, effective 1/1/2017 39 CR 22, November 25, 2016, effective 1/1/2017 39 CR 23, December 10, 2016, effective 1/1/2017 39 CR 23, December 25, 2016, effective 1/1/2017 40 CR 03, February 10, 2017, effective 3/15/2017 40 CR 09, May 10, 2017, effective 6/1/2017 40 CR 15, August 10, 2017, effective 9/1/2017 40 CR 17, September 10, 2017, effective 10/1/2017 40 CR 21, November 10, 2017, effective 12/1/2017 41 CR 04, February 25, 2018, effective 4/1/2018 41 CR 05, March 10, 2018, effective 6/1/2018 41 CR 08, April 25, 2018, effective 6/1/2018 41 CR 09, May 10, 2018, effective 6/1/2018 41 CR 11, June 10, 2018, effective 7/1/2018 41 CR 15, August 10, 2018, effective 9/1/2018 41 CR 17, September 10, 2018, effective 10/1/2018 41 CR 18, September 25, 2018, effective 10/15/2018 41 CR 21, November 10, 2018, effective 12/1/2018 41 CR 23, December 10, 2018, effective 1/1/2019 42 CR 01, January 10, 2019, effective 2/1/2019 41 CR 19, October 10, 2018, effective 3/1/2019 42 CR 03, February 10, 2019, effective 4/1/2019 42 CR 04, February 25, 2019, effective 4/1/2019 42 CR 06, March 25, 2019, effective 6/1/2019 42 CR 08, April 10, 2019, effective 6/1/2019 42 CR 15, August 10, 2019, effective 9/1/2019 42 CR 17, September 10, 2019, effective 10/1/2019 43 CR 02, January 25, 2020, effective 12/20/2019 43 CR 02, January 25, 2020, effective 12/23/2019 42 CR 23, December 10, 2019, effective 1/1/2020 43 CR 01, January 10, 2020, effective 2/1/2020 42 CR 24, December 25, 2019, effective 2/2/2020 43 CR 06, March 25, 2020, effective 4/15/2020 43 CR 10, May 25, 2020, effective 8/1/2020 43 CR 14, July 25, 2020, effective 8/15/2020 43 CR 17, September 10, 2020, effective 10/1/2020 43 CR 18, September 25, 2020, effective 11/1/2020 43 CR 22, November 25, 2020, effective 12/15/2020 43 CR 24, December 25, 2020, effective 1/15/2021 44 CR 03, February 10, 2021, effective 3/15/2021 44 CR 08, April 25, 2021, effective 5/15/2021 44 CR 09, May 10, 2021, effective 6/1/2021 44 CR 10, May 25, 2021, effective 6/14/2021 44 CR 10, May 25, 2021, effective 6/15/2021 44 CR 13, July 10, 2021, effective 8/1/2021 44 CR 15, August 10, 2021, effective 9/1/2021 44 CR 19, October 10, 2021, effective 11/1/2021 44 CR 21, November 10, 2021, effective 12/1/2021 44 CR 23, December 10, 2021, effective 12/30/2021 44 CR 21, November 10, 2021, effective 1/1/2022 44 CR 23, December 10, 2021, effective 1/15/2022 44 CR 24, December 25, 2021, effective 1/15/2022 45 CR 03, February 10, 2022, effective 3/2/2022 45 CR 08, April 25, 2022, effective 5/30/2022 45 CR 09, May 10, 2022, effective 5/30/2022 45 CR 10, May 25, 2022, effective 6/14/2022 45 CR 11, June 10, 2022, effective 6/30/2022 45 CR 11, June 10, 2022, effective 7/15/2022 45 CR 19, October 10, 2022, effective 11/1/2022 45 CR 20, October 25, 2022, effective 11/14/2022 45 CR 21, November 10, 2022, effective 11/30/2022 45 CR 24, December 25, 2022, effective 1/14/2023 46 CR 01, January 10, 2023, effective 2/14/2023 46 CR 06, March 25, 2023, effective 2/15/2023 46 CR 03, February 10, 2022, effective 3/2/2023 46 CR 04, February 25, 2023, effective 3/17/2023 46 CR 05, March 10, 2023, effective 4/15/2023 46 CR 09, May 10, 2023, effective 5/30/2023 46 CR 09, May 10, 2023, effective 6/1/2023 46 CR 10, May 25, 2023, effective 6/15/2023 46 CR 11, June 10, 2023, effective 6/30/2023