INSTANT-Annuity Suitability Quote

	Applicant	Joint Annuitant
Do you currently own life insurance? Please List:
Does your income cover all your living expenses including medical?
Do you anticipate changes in your out-of-pocket medical expenses?
Is your income sufficient to cover future changes in your living and/or out-of-pocket medical expenses during the surrender period?
Do you have an emergency fund for unexpected expenses?

Why are you purchasing this annuity?*
What are your financial objectives for purchase? (Check all that apply)*

IncomeGrowth(long term)Safety of Principal and IncomePass assets to a beneficiary or beneficiaries at deathOther
Describe your risk tolerance(Check all that apply)*

ConservationModerately ConservativeModerateModerately AggressiveAggressiveOther
What is the source of the funds for the purchase of the proposed annuity?*
How many years from today will you need access to your funds without a penalty?*

	Yes	No
Will the proposed annuity replace any product?
If yes,will you pay a penalty or other charger to obtain these funds?