Annuity Surrender Form

Annuity Surrender Form
ACTION DISCLOSURE

Strategic repositioning of assets to align with the attainment of long term financial goals may result in current expenses, current taxes or loss of current financial benefits. There is no guarantee that goals will be achieved by repositioning current assets. This disclosure will serve to identify areas that must be carefully considered prior to taking action to discontinue current asset positioning.
Advisor Name

First NameLast Name
Client Name

First NameLast Name
Age
Date of Birth

MonthDayYear
Date
Current Asset:
Type of Product
Type of Contract
Contract or Account Number
Date Acquired

MonthDayYear
Date
Account Type

Approximate: