Washington Administrative Code › Title 284 - Insurance Commissioner, Office of the › Chapter 284-23 - Washington life insurance regulations › REPLACEMENT REGULATION › Section 284-23-485 - Form to be used for notice regarding replacement

Current through Register Vol. 24-14, July 15, 2024
(Insurance company's name and address)
IMPORTANT NOTICE REGARDING REPLACEMENT OF
INSURANCE
(Save this notice! It may be important to you in the
				  future.)
The decision to buy a new life insurance policy or annuity
				  and discontinue or change an existing one is very important. Your decision
				  could be a good one -- or a mistake. It should be carefully considered. The
				  Washington state insurance commissioner requires us to give you this notice to
				  help you make a wise decision.
STATEMENT TO APPLICANT BY INSURANCE PRODUCER:
(Use additional sheets, as necessary.)
I believe the replacement of insurance involved in this
				  transaction materially improves your position. My conclusion has taken into
				  account the following factors, which I call to your attention.
1.Can there be reduced benefits or increased
				premiums in later years? . . . No . . . Yes, explain:
2.Are there penalties, set up or surrender
				charges for the new policy? . . . No . . . Yes, explain, emphasizing any extra
				cost for early withdrawal:
3.Will
				there be penalties or surrender charges under the existing insurance as a
				result of the proposed transaction?
. . . No . . . Yes, explain:
4.Are there adverse tax consequences from the
				replacement under current tax law?. . . No . . . Yes, explain:
5.
a)
Are interest earnings a consideration in this
								replacement? No. . . . Yes. . ..
b)
If "yes," explain what portions of premiums or
								contributions will produce limited or no earnings. As pertinent, include in
								your explanation the need for minimum deposits to enhance earnings, and the
								reduction of earnings that may result from set-up charges, policy fees, and
								other factors.
6.Are minimum amounts required to be on
				deposit before excess interest will be paid? . . . No . . . Yes, explain:
7. If the new program is based on a variable or
								universal life insurance policy or a single-premium policy or annuity:
a)
Are the interest rates quoted before . . . or after
								. . . fees and mortality charges have been deducted?
b)
Interest rates are guaranteed for how long? . .
								.
c)
The minimum interest rate to be paid is how much? .
								..
d)
If applicable, the rate you pay to borrow is . . .
								. ., and the limit on the amount that can be borrowed is . . . ..
e)
The surrender charges are . . . ..
f)
The death benefit is . . . ..
8.Are there other short or long term effects
				from the replacement that might be materially adverse?
. . . No. . . Yes, explain:
. . . . . . . . . . ..
Signature of Insurance Producer
. . . . . . . . . . ..
Date
. . . . . . . . . . ..
Name of Insurance Producer
(Print or Type)
. . . . . . . . . . ..
. . . . . . . . . . ..
Address
List of Policies or Contracts to be
								Replaced:
Company
Insured
Contract No.
CAUTION: The insurance commissioner suggests you consider
				  these points:
Usually, contestable and suicide periods start again under a
				  new policy. Benefits might be excluded under a new policy that would be paid
				  under existing insurance.
Terminating or altering existing coverage, before new
				  insurance has been issued, might leave you unable to purchase other life
				  insurance or let you buy it only at substantially higher rates.
You are entitled to advice from the existing insurance
				  producer or company. Such advice might be helpful.
Study the comments made above by the insurance producer. They
				  apply to you and this proposal. They are important to you and your
				  future.
Completed Copy
Received: . . . . . . . . . . ..
(Applicant's Signature) (Date)
THIS COMPLETED FORM SHOULD BE FILED PERMANENTLY WITH YOUR NEW
				  INSURANCE POLICY.
Statutory Authority:
					 RCW
					 48.02.060(3)(a) and
					 48.17.010(5).
					 11-01-159 (Matter No. R 2010-09), §
											284-23-485, filed 12/22/10,
					 effective 1/22/11. Statutory Authority:
					 RCW
					 48.02.060. 87-14-015 (Order R 87-6), §
											284-23-485, filed 6/23/87,
					 effective 9/1/87.