Notice To Owner Regarding Replacement Of Life Insurance
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7Notice to Owner Regarding
Replacement of Life Insurance
Exhibit A
(Used for Internal and External Replacements)
M M a a s s s s a a c c h h u u s s e e t t t t s s M M u u t t u u a a l l L L i i f f e e I I n n s s u u r r a a n n c c e e C C o o m m p p a a n n y y
C C . . M M . . L L i i f f e e I I n n s s u u r r a a n n c c e e C C o o m m p p a a n n y y
M M M M L L B B a a y y S S t t a a t t e e L L i i f f e e I I n n s s u u r r a a n n c c e e C C o o m m p p a a n n y y
1 1 2 2 9 9 5 5 S S t t a a t t e e S S t t r r e e e e t t S S p p r r i i n n g g f f i i e e l l d d M M A A 0 0 1 1 1 1 1 1 1 1 - - 0 0 0 0 0 0 1 1
4 4 1 1 3 3 - - 7 7 8 8 8 8 - - 8 8 4 4 1 1 1 1
MUST BE PRESENTED TO, SIGNED AND DATED BY THE OWNER AND PRODUCER AT THE TIME OF APPLICATION
A decision to buy a new policy and discontinue or change an existing policy may be a wise choice or a mistake.
Get all the facts. Make sure you fully understand both the proposed policy and your existing policy or policies. New policies may contain
clauses which limit or exclude coverage of certain events in the initial period of the contract, such as the suicide and incontestable claus-
es which may have already been satisfied in your existing policy or policies.
Your best source for facts on the proposed policy is the proposed company and its agent. The best source on your existing policy is the exist-
ing company and its agent.
Hear from both before you make your decision. This way you can be sure your decision is in your best interest.
If you indicate that you intend to replace or change an existing policy, Florida regulations require notification of the company that issued the
policy.
Florida regulations give you the right to receive a written Comparative Information Form which summarizes your policy values. Indicate
whether or not you wish a Comparative Information Form from the proposed company and your existing insurer or insurers by placing your
initials in the appropriate box below.
YES
NO
n n
n n
Do not take action to terminate your existing policy until your new policy has been issued and you have examined it and found it acceptable.
.
Agreements and Signatures
I have read this notice and received a copy of it.
x
__________________________________________________________________________
________________________________
Date
Signature of Owner
x
__________________________________________________________________________
________________________________
Signature of Producer
Date
_______________________________________________________________________________________________________________
Producer’s Name (printed or typed)
Producer’s Company (printed or typed)
_______________________________________________________________________________________________________________
Producer’s Address (No. & Street, City, State, Zip)
Information on Policies which may be replaced:
Company Name
Policy Number
Name of Insured
(A signed and dated copy of this notice must accompany the application.)
F5436FL REV. 807
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