Ill. Admin. Code tit. 50, § 917.EXHIBIT B
(Name of Existing Insurer)
(Address)
(City, State, Zip Code )
(Salutation)
You are herewith given notice that we are in receipt of application(s) for life insurance or annuity(ies) for an individual presently insured with your company.
Identification
| Name of Insured | |||
| Address | |||
| Contract Number | |||
| " " | |||
| " " | |||
| " " |
This notice is given pursuant to 50 Ill. Adm. Code 917.70(c)
| (Insurance Producer's Signature) | (Closure) |