Wyoming Administrative Code › Agency 044 - Insurance Dept › Sub-Agency 0002 - General Agency, Board or Commission Rules › Chapter 12 - REGULATION GOVERNING REPLACEMENT OF LIFE INSURANCE POLICIES AND ANNUITIES › Exhibit A

Current through July 13, 2024
REPLACEMENT NOTICE
ASK QUESTIONS -- IT'S YOUR MONEY -- GET THE FACTS
Whether it is to your advantage to replace or change your
				  existing insurance or annuity program, only you can decide. It is in your best
				  interest to obtain adequate information in order to compare relatively short
				  and long range costs and benefits before a final decision is made.
The producer or insurance company assisting you with this new
				  purchase must notify your existing producer or company so that they may prepare
				  a detailed, current statement concerning your existing program for your
				  comparison. Statements and illustrations should not, however, be used as the
				  sole basis to compare policies or contracts. We want you to understand the
				  effects of replacements before you make your purchase decision, and ask that
				  you review the statements listed under "Items to Consider."
EXISTING INSURANCE WHICH MAY BE REPLACED OR CHANGED
Full Name of
Insurance Company
Including Home Policy or Contract
Office Location Number* Insured
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
Surrender Charge of Policy Being Replaced _______ % and $
				  ____________
Sales Charge of Policy Being Purchased (if applicable) $
				  _______________
New Surrender Period and Surrender Charges of
				  Policy Being Purchased.
YEARS
% CHARGE
YEARS
% CHARGE
* If a number has not been assigned by the existing insurer,
				  indicate alternative identification, such as an application or receipt
				  number.
ITEMS TO CONSIDER
1.
				Due to a possible change in insurability status (health, occupation or high
				risk recreational activities) you might be denied new coverage, or the premium
				may be higher than a standard premium.
2. The Incontestability and Suicide Clause
				time periods would probably begin anew in a new policy. This could possibly
				result in a claim being denied that might otherwise have been paid under an
				existing policy or contract.
3.
				Your present insurance company may be able to modify your existing plan on
				terms which may be more favorable for you than completely replacing it with a
				new policy or contract.
4. Don't
				terminate or alter your existing policy until after the new policy has been
				delivered to you and accepted by you.
5. If you terminate your existing policy, you
				may incur surrender charges and/or penalties. The new policy you are purchasing
				may have a new surrender charge period and/or sales charges.
6. There may be tax consequences in replacing
				an existing policy. Is there a benefit from favorable "grandfathered" treatment
				of the old policy under the federal tax code? Is this transaction a "tax free"
				exchange? See your tax advisor for specific tax advice regarding the proposed
				transaction.
7. Take your time in
				making your decision about purchasing the new policy. Gather all information
				about the new policy and compare it to your old policy. Remember, you do not
				have to make a decision during the first meeting with your sales
				person.
8. REMEMBER: Following
				receipt of a new life insurance policy or annuity contract you should
				immediately examine its contents. If you are not satisfied with it for any
				reason, you have the right to return it within the thirty (30) day "examination
				period" to the insurer at its home office or branch office or to the producer
				through whom it was purchased, for a full refund of premium. If you do return
				the policy or contract, you should request a dated receipt indicating that it
				was returned.
DID YOU READ THE "ITEMS TO CONSIDER"? _______________________
				  ________ _______________________ ________
Applicant's Signature Date Producer's Signature Date
__________________________________
				  __________________________________
Applicant's Name (printed) Producer's Name (printed) and
				  License No.
__________________________________
				  __________________________________
Address Address
__________________________________
				  __________________________________
City, State, Zip Code City, State, Zip Code
__________________________________
				  __________________________________
Telephone Number Telephone Number