Replacement Form IL Exhibit A

Page 1

Important Notice: Replacement of Life Insurance or Annuities

EXHIBIT A

MUST BE PRESENTED TO, SIGNED AND DATED BY THE OWNER AND PRODUCER AT THE TIME OF APPLICATION

Are you thinking about buying a new life insurance policy and discontinuing or changing an existing one? If you are, your decision could be a good one - or a mistake. You will not know for sure unless you make a careful comparison of your existing benefits and the proposed benefits.

Make sure you understand the facts. You should ask for the advice of the company or agent that sold you your existing policy to give you information about it.

Hear both sides before you decide. This way you can be sure you are making a decision that is in your best interest. We are required by law to notify your existing company that you may be replacing their policy.

The following policy(ies) may be replaced as a result of this transaction:

IP-RPL-IL-EXA-0422-V1 Page 1 of 1
4254 Saw Mill Run Blvd., Pittsburgh, PA 15227
Insurer Name Contract or Policy # Insured or Annuitant Face Amount Plan Name (Generic) Owner’s Signature Date Producer’s Signature Date Phone: 412-884-5100 | 800-765-4428 | newbusiness@gbu.org  | gbu.org
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