AGENT USE ONLY. A. To the best of your knowledge, does the customer have any existing annuity or life insurance contracts? _Yes_No B. To the best of your knowledge, has or will this annuity replace or change any annuity or life insurance (including borrowing)? _Yes_No Agent Name (Please Print) Agent Signature Agent No. Phone No. Fax No. E-mail Address Florida License No. FIC259 Page 2 of 3 SKU# FIC259 (03/08)
Appears in 1 contract
Sources: Group Contingent Deferred Annuity Master Contract (Allstate Life Insurance Co)
AGENT USE ONLY. A. To the best of your knowledge, does the customer have any existing annuity or life insurance contracts? _Yes_No
B. To the best of your knowledge, has or will this annuity replace or change any annuity or life insurance (including borrowing)? _Yes_No Agent Name (Please Print) Agent Signature Agent No. Phone No. Fax No. E-mail Address Florida License No. FIC259 Page 2 of 3 SKU# FIC259 (03/08)
Appears in 1 contract
Sources: Group Contingent Deferred Annuity Master Contract (Allstate Life Insurance Co)