Gift Annuity Application Form printable pdf download

Gift Annuity Application Form

The University of Tennessee Foundation

c/o Office of Planned Giving

Phone: (865) 974-4826 -- Fax: (865) 974-8870

GIFT ANNUITY APPLICATION

I (we) hereby make application for a gift annuity subject to the following terms and conditions:

Donor(s) (Enter both names if property is jointly-owned or community property; otherwise enter one name)

Name ____________________________________

Name ___________________________________

SS# __________________Date of birth _________

SS# __________________ Date of birth_______

Address __________________________________

Address ______________________________

City ________________ State _____ ZIP _______

City ________________ State _____ ZIP ______

Daytime phone ( ___ ) ______________

Email Address ______________________________

Email Address ____________________________

Annuitant(s)

Check one:

___ One annuitant

___ Two joint and survivor annuitants (payments to both jointly, continuing to the the survivor)

___ Two successive annuitants (payments to one, then to the survivor)

If annuitant(s) is (are) other than the donor(s), complete the following:

First annuitant ___________________________________________________ Date of birth ___________

Street address _______________________City _________________________ State ____ ZIP ________

SS# _____________________________

Relationship to donor(s) __________________________

Second annuitant ______________________________________________ Date of birth ______________

Street address ________________________City __________________________State____ ZIP ________

SS# _______________________________

Relationship to donor(s) __________________________

Annuity type:

Will payment of the annuity be immediate or deferred?

____ Immediate

____ Deferred

If deferred complete either (a) or (b) below:

(a) Payments are to begin on this specific date: _____________________.

(b) Payments may begin on _________in any year during the period ___________and __________

(indicate month/day)

(1st possible year) (last possible year)

Payment frequency: Quarterly (March 31, June 30, September 30, December 31)

Gift Annuity Application Form