Bulletin 1987-8

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STATE OF KANSAS

KANSAS

INSURANCE DEPARTMENT

420 S.W. 9th

Topeka 66612-1678 913-296-3071

1-800-432-2484

Consumer Assistance

Division calls only

FLETCHER BELL

Commissioner

# Bulletin 1987-8

TO: All Life Insurers Authorized in Kansas

FROM: Fletcher Bell

Commissioner of Insurance

SUBJECT: Single Premium Deferred Annuity Disclosure Form

DATE: April 2, 1987

The purpose of this bulletin is to disseminate the disclosure forms required by K.A.R. 40-2-14, as amended effective May 1, 1987.

K.A.R. 40-2-14(d)(2) states that, "at the time an application is taken for a single premium deferred annuity, the disclosure form prescribed by the commissioner shall be executed by the applicant and the selling agent and attached to the application".

Attached to this bulletin is a copy of the disclosure form prescribed by the Commissioner of Insurance. This document must be utilized by each company without change except for possibly reprinting the document on the company's letter head, etc. No policy or contract to which the above mentioned requirement applies shall be delivered after May 1, 1987, unless the prescribed form has been attached to the application.

If you have any questions regarding this bulletin, please contact the Life Division (913)296-7855.

Very truly yours,

Fletcher Bell

Commissioner of Insurance

FB:mkb:res

# Single Premium Deferred Annuity

Disclosure Form

IMPORTANT: READ THIS FORM CAREFULLY BEFORE BUYING THIS ANNUITY

t applies shall be delivered after May 1, 1987, unless the prescribed form has been attached to the application.

If you have any questions regarding this bulletin, please contact the Life Division (913)296-7855.

Very truly yours,

Fletcher Bell

Commissioner of Insurance

FB:mkb:res

# Single Premium Deferred Annuity

Disclosure Form

IMPORTANT: READ THIS FORM CAREFULLY BEFORE BUYING THIS ANNUITY

1. A Single Premium Deferred Annuity ("SPDA") is an insurance product which, under current Federal tax laws, allows the buyer to accrue interest for a period of years without having to pay tax on the interest until he or she cashes the annuity or arranges to receive regular payments.

2. No annuity is "risk free" or "guaranteed safe" and should not be described as such. An annuity is only as sound as the stability of the issuing insurance company.

3. From the beginning of this annuity contract, the insurance company guarantees an interest rate of ___% for a period of ___month(s) or ___year(s).

(Selling agents must fill in all blanks if applicable; if not applicable, write ("N/A")

Subsequent interest guarantees are as follows:

4. Early cash surrender of this annuity may result in a penalty being charged.

5. This form must be completed at the time the application for the SPDA is taken and must be attached to the application.

Company Name Date

Buyers Signature Date

Selling Agent's Signature Date

(No other language shall be printed or written on this page)