760 Ind. Admin. Code 1-72-9
Authority: IC 27-4-9-4
Affected: IC 27-1-15.6-12; IC 27-4-1-4; IC 27-4-9
Sec. 9.
The consumer decision to purchase an annuity not based on a recommendation form is as follows:
Consumer Decision to Purchase an Annuity NOT Based on a Recommendation
Do Not Sign This Form Unless You Have Read and Understand It.
Why are you being given this form? You are buying a financial product - an annuity.
To recommend a product that effectively meets your needs, objectives and situation, the agent, broker, or company has the responsibility to learn about you, your financial situation, insurance needs and financial objectives.
If you sign this form, it means you know that you're buying an annuity that was not recommended.
Statement of Purchaser:
I understand that I am buying an annuity, but the agent, broker or company did not recommend that I buy it. If I buy it without a recommendation, I understand I may lose protections under the Insurance Code of Indiana.
________________________________________________
Customer Signature
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Date ________________________________________________
Agent/Producer Signature
________________________________________________
Date
760 IAC 1-72-9