Exhibit B - Notice Regarding Proposed Replacement of Life Insurance or Annuity

Current through Register Vol. 46, No. 15, April 8, 2022

(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

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