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 ________________________________________________ Date ________________________________________________ Agent/Producer Signature ________________________________________________ Date

(Department of Insurance; 760 IAC 1-72-9; filed Feb 8, 2024, 12:47 p.m.: 20240306-IR-760230518FRA, eff Jul 1, 2024)