NO DATE: August 17, 2011

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1 NO DATE: August 17, 2011 TO: FROM: SUBJECT: All Agents Licensed in Texas James P. Payne, Compliance Officer Suitability in Annuity Transactions The purpose of this Compliance Bulletin is to inform you of the new annuity suitability requirements adopted by Texas and the resulting procedural changes that you must follow when selling any National Western annuity product to consumers of all ages. A copy of the regulation is attached. Please take the time to read this bulletin and the accompanying regulation carefully and to familiarize yourself with all of the requirements. Texas adopted amendments to Chapter 1115 of the Insurance Code, Suitability of Certain Annuity Transactions ; the regulation provides standards and procedures for recommendations to consumers that result in transactions involving annuity products so that the insurance needs and financial objectives of consumers at the time of the transactions are appropriately addressed. The amendments bring the Texas regulation into accord with a new model regulation drafted by the National Association of Insurance Commissioners (NAIC) in NEW ANNUITY SUITABILITY QUESTIONNAIRE SEPTEMBER 1, 2011 COMPLIANCE DATE As a result of the new regulation in Texas, National Western has created a new Annuity Suitability Questionnaire that must be used with all annuity applicants in Texas. Effective September 1, 2011, National Western is requiring that Form DM-1174 (or any future revisions thereof) be used with all annuity applicants. This form must accompany all annuity applications dated on or after September 1, 2011, and you should keep a copy of the form for your records. National Western will not issue an annuity unless it has received a properly completed, signed Annuity Suitability Questionnaire. A copy of Form DM-1174 is attached to this bulletin and can be ordered from the Company or downloaded from BEACON. Again, please read the attached regulation carefully and familiarize yourself with the new Annuity Suitability Questionnaire, Form DM-1174, as there are substantial differences from the previous requirements in Texas. For example, please note the following: You are required to obtain more extensive, detailed information from the consumer defined as suitability information under the Texas regulation such as liquidity needs, liquid net worth, risk tolerance, source of funds, and financial time horizon, in addition to other information that is now required under Texas law to determine the suitability of a recommendation. A consumer may not opt out of completing the new Annuity Suitability Questionnaire. This form is required for every application in Texas and must be completed in its entirety. (over) SH-1006.Rev.5.06

2 In the case of an exchange or replacement of an annuity, the new questionnaire requires that you obtain information regarding surrender charges, any loss of benefits, and previous exchange/replacement activity. National Western must now have procedures to review each of its insurance agent s recommendations prior to the issuance of an annuity that are designed to ensure that there is a reasonable basis to determine that a recommendation is suitable. National Western created its Annuity Suitability Questionnaire, and requires its use in all annuity sales, in order to assist our insurance agents in obtaining information from the consumer that would enable them to make suitable recommendations for the purchase or exchange of an annuity. It is your responsibility to make suitable recommendations based on the facts disclosed by the consumer. Again, please remember that Form DM-1174 (or any future revisions thereof) must be completed in its entirety (including the explanation section of the Agent Certification), all questions answered, and properly initialed and signed where indicated on the form. NEW INSURANCE AGENT TRAINING REQUIREMENTS The amended regulation in Texas now requires that annuity agents who sell to Texas residents must complete two training components: 1) One-time, four credit general annuity training course approved by the Department and provided by a Department-approved education provider; and 2) Product-Specific Training with any and all annuity carriers for which you will solicit or sell annuities. National Western is a member of the National Association for Fixed Annuities (NAFA), and as a NAFA member, we were able to partner with them to assist you in complying with both the onetime, four-credit general annuity training and National Western s Product-Specific Training. At any time beginning September 1, 2011 or after, please login to National Western s agentfriendly website, BEACON, and click on the NAFA banner on the right side of your screen to access both the Product-Specific Training and CE course. Once on their website, please click the box entitled *SELECT* Your Annuity Product Specific Training, select the course entitled National Western Product Specific Training for Annuities, and click Add Selected Courses. If you only need to take the Product-Specific Training, simply click Add Selected Course to Cart and proceed to finish. To add the CE course as well, click Select Annuity Suitability and CE Training and then click on Texas. Select your license type (Life, Annuity, and Health Insurance CE) and then scroll down and click the box to select Texas s NAIC Suitability in Annuity Transactions CE course. Once you have made your selections, click Check Out and follow the screen prompts to continue to your training program(s). More specific information about each program is provided below. NWL Product-Specific Training March 1, 2012 Compliance Date Under the new Texas rule, an insurance agent may not solicit the sale of any annuity product unless he or she has adequate knowledge of the product to recommend the annuity. In order to ensure that its agents are complying with this requirement, National Western has designed a Product-Specific Annuity Training program to provide product-specific training on its respective annuity products. This program will be available through BEACON starting September 1, 2011.

3 This product-specific training program is a 1.5-hour course that is based on our consumer disclosure brochures and is designed to provide you with knowledge of the types of annuity products offered by National Western as well as the specific features each product provides. To access this course beginning September 1, 2011, please follow the instructions provided above. Please remember that National Western will not be able to accept any annuity business from you if you have not completed the Product-Specific Training prior to soliciting the sale of an annuity on or after March 1, General Annuity Training Course March 1, 2012 Compliance Date All insurance agents who hold a life insurance line of authority as of September 1, 2011 and who desire to sell annuities must complete this training requirement by March 1, NAFA s continuing education partner, SuccessCE, offers Texas s NAIC Suitability in Annuity Transactions CE course, which has been approved by the Texas Department of Insurance and meets this training requirement. To access this course, please follow the instructions provided above. At the end of this course, SuccessCE will notify National Western that you have completed your one-time, four-credit general annuity training course, as National Western is required by the Texas regulation to verify that you have completed the required training. If you have already completed this training requirement with another authorized provider, you may , fax, or mail your Certificate of Completion to National Western via the following methods: 1. rgenz@globalnw.com 2. Fax: (512) Mail: National Western Life Insurance Company Attn: Robin Genz Licensing Supervisor 850 East Anderson Lane Austin, Texas National Western will only accept Certificates of Completion for courses that are approved by the Texas Department of Insurance for this training requirement. Please remember that National Western will not be able to accept any annuity business from you if you have not completed this four-credit general annuity training requirement prior to soliciting the sale of an annuity on or after March 1, If you have any problems using our website and/or accessing the training programs, our Marketing Department is ready to assist you. Please direct any questions you may have concerning this Compliance Bulletin to the Marketing Department ( ). JPP/gbm This Compliance Bulletin supersedes Compliance Bulletins 32-04, 02-05, 15-07, and

4 Vernon s Texas Statutes and Codes Annotated Insurance Code Title 7 Life Insurance and Annuities Subtitle A Life Insurance in General Chapter 1115 SUITABILITY OF CERTAIN ANNUITY TRANSACTIONS Sec PURPOSE. The purpose of this chapter is to establish standards and procedures regarding recommendations made to a consumer that result in a transaction involving annuity products, and to require insurers to establish a system to supervise those recommendations, to ensure that the insurance needs and financial objectives of the consumer as of the time of the transaction are appropriately addressed. Section DEFINITIONS. In this chapter: (1) Agent means an individual who holds a license under Chapter 4054 and who sells, solicits, or negotiates insurance or annuity contracts in this state. (2) "Annuity" means an annuity that is an insurance product under the laws of this state that is individually solicited, whether the product is classified as an individual annuity or group annuity. (2-a) "Continuing education provider" means a person authorized to offer continuing education courses under Chapter (3) "Insurer" means a company authorized to engage in the business of life insurance and annuities in this state. (4) "Recommendation" means advice provided by an agent, or an insurer if no agent is involved, to an individual consumer that results in a purchase, exchange, or replacement of an annuity made in accordance with that advice. (5) "Replacement" means a transaction in which a new policy or contract is to be purchased and the proposing agent, or the proposing insurer if an agent is not involved, knows or should know that, by reason of the transaction, an existing policy or contract has been or is to be: (A) lapsed, forfeited, surrendered or partially surrendered, assigned to the replacing insurer, or otherwise terminated; (B) converted to reduced paid-up insurance, continued as extended term insurance, or otherwise reduced in value by the use of nonforfeiture benefits or other policy values; (C) amended so as to effect either a reduction in benefits or in the term for which coverage would otherwise remain in force or for which benefits would be paid; (D) reissued with any reduction in cash value; or (E) used in a financed purchase. (6) "Suitability information" means information that is reasonably appropriate to determine the suitability of a recommendation, including the following: (A) age; (B) annual income; (C) financial situation and needs, including the financial resources used for the funding of the annuity; (D) financial experience; (E) financial objectives; (F) intended use of the annuity; (G) financial time horizon; (H) existing assets, including investment and life insurance holdings; (I) liquidity needs; (J) liquid net worth; (K) risk tolerance; and (L) tax status. 1

5 Sec APPLICABILITY; EXEMPTIONS. (a) This chapter applies to any recommendation to purchase, replace, or exchange an annuity that: (1) is made to a consumer by an agent, or an insurer if an agent is not involved; and (2) results in the recommended purchase, replacement, or exchange. (b) Unless otherwise specifically included, this chapter does not apply to transactions involving: (1) direct response solicitations if there is no recommendation based on information collected from the consumer under this chapter; or (2) contracts used to fund: (A) an employee pension benefit plan or employee welfare benefit plan covered by the Employee Retirement Income Security Act of 1974 (29 U.S.C. Section 1001 et seq.); (B) a plan described by Section 401(a), 401(k), 403(b), 408(k), or 408(p), Internal Revenue Code of 1986, if established or maintained by an employer; (C) a government or church plan, as defined by Section 414, Internal Revenue Code of 1986, a government or church welfare benefit plan, or a deferred compensation plan of a state or local government or tax exempt organization described under Section 457, Internal Revenue Code of 1986; (D) a nonqualified deferred compensation arrangement established or maintained by an employer or plan sponsor; (E) settlements of or assumptions of liabilities associated with personal injury litigation or any dispute or claim resolution process; or (F) prepaid funeral benefits contracts, as defined by Chapter 154, Finance Code. Sec NO CAUSE OF ACTION CREATED. This chapter may not be construed to create or imply a private cause of action for a violation of this chapter. Sec RULES. The commissioner may adopt reasonable rules in the manner prescribed by Subchapter A, Chapter 36, to accomplish and enforce the purpose of this chapter. Sec SUITABILITY OF ANNUITY PRODUCT REQUIRED. (a) In recommending to a consumer the purchase of an annuity or the exchange of an annuity that results in another insurance transaction or series of insurance transactions, the agent, or the insurer if an agent is not involved, must have a reasonable basis to believe that: (1) the recommendation is suitable for the consumer on the basis of the facts disclosed by the consumer as to the consumer's investments and other insurance products and as to the consumer's financial situation and needs, including the consumer's suitability information; (2) the consumer has been reasonably informed of various features of the annuity, such as the potential surrender period and the surrender charge, any potential tax penalty if the consumer sells, exchanges, surrenders, or annuitizes the annuity, mortality and expense fees, investment advisory fees, potential charges for and features of riders, limitations on interest returns, insurance and investment components, and market risk; (3) the consumer would benefit from certain features of the annuity, such as tax-deferred growth, annuitization, or a death or living benefit; (4) the particular annuity as a whole, the underlying subaccounts to which funds are allocated at the time of the purchase or exchange of the annuity, and any riders or similar product enhancements are suitable, and, in the case of an exchange or replacement, the transaction as a whole is suitable, for the particular consumer based on the consumer's suitability information; and (5) in the case of an exchange or replacement of an annuity, the exchange or replacement is suitable, including taking into consideration whether the consumer: (A) will incur a surrender charge, be subject to the commencement of a new surrender period, lose existing benefits such as death, living, or other contractual benefits, or be subject to increased fees, investment advisory fees, or charges for riders or similar product enhancements; (B) would benefit from product enhancements and improvements; and (C) has had another annuity exchange or replacement, and in particular, an exchange or replacement in the preceding 36 months. 2

6 (b) Before the execution of a purchase, exchange, or replacement of an annuity resulting from a recommendation, an agent, or an insurer if an agent is not involved, shall make reasonable efforts to obtain the consumer's suitability information. (c) Except as permitted by Subsection (d), an insurer may not issue an annuity recommended to a consumer unless the insurer has a reasonable basis to believe the annuity is suitable based on the consumer's suitability information. (d) Subject to Subsection (e), an agent or insurer does not have any obligation to a consumer related to an annuity transaction if: (1) the consumer refuses to provide suitability information requested by the agent or insurer; (2) the agent or insurer does not make a recommendation; (3) the agent or insurer makes a recommendation later found to have been prepared based on inaccurate material information provided by the consumer; or (4) the consumer decides to enter into a transaction that is not based on a recommendation of the agent or insurer. (e) An insurer's issuance of an annuity under circumstances described by Subsection (d) must be reasonable under all circumstances actually known to the insurer at the time the annuity is issued. (f) An agent, or an insurer if an agent is not involved, shall at the time of sale of an annuity: (1) make a record of any recommendation made by the agent or insurer that is subject to Subsection (a); (2) obtain a customer-signed statement documenting the customer's refusal, if any, to provide suitability information; and (3) obtain a customer-signed statement acknowledging that an annuity transaction is not recommended if the customer decides to enter into an annuity transaction that is not based on the agent's or insurer's recommendation. Sec SUPERVISION COMPLIANCE SYSTEM. (a) Each insurer shall establish supervision that is reasonably designed to achieve the insurer's and the insurer's agents' compliance with this chapter. (b) An insurer may comply with Subsection (a) by establishing and maintaining the insurer's own supervision system under which, at a minimum, the insurer: (1) maintains reasonable procedures to inform the insurer's agents of the requirements of this chapter and incorporates the requirements of this chapter into relevant agent training manuals; (2) establishes standards for agent product training and maintains reasonable procedures to require the insurer's agents to comply with the requirements of Section ; (3) provides product-specific training and training materials that explain all material features of the insurer's annuity products to the insurer's agents; (4) maintains procedures to review each recommendation electronically, physically, or otherwise before the issuance of an annuity that: (A) are designed to ensure that there is a reasonable basis to determine that a recommendation is suitable; and (B) may: (i) include the application of a screening system to identify selected transactions for additional review; and (ii) be designed to require additional review only of those transactions identified for additional review by the selection criteria; (5) maintains reasonable procedures, such as confirmation of consumer suitability information, systematic customer surveys, interviews, confirmation letters, and programs of internal monitoring, to detect recommendations that are not suitable, which may involve applying sampling procedures or confirming suitability information after the issuance or delivery of the annuity; and (6) annually provides a report to the insurer's senior management, including to the senior manager responsible for audit functions, that details a review, with appropriate testing, reasonably designed to determine the effectiveness of the supervision system, the exceptions found, and any corrective action taken or recommended. (c) This subsection does not prohibit an insurer from contracting for the performance of a function, including maintenance of procedures, required by Subsection (b). An insurer's supervision system under Subsection (b) must include the supervision of contractual performance under this subsection that includes, at a minimum (1) annually obtaining certification that complies with Section from a senior manager who represents that the contracted function is properly performed; and (2) monitoring and, as appropriate, conducting audits to ensure that the contracted function is properly performed. 3

7 (d) An insurer is not required by this section to: (1) review, or provide for review of, all agent-solicited transactions; or (2) include in the supervision system an agent's recommendations to consumers of products other than the annuities offered by the insurer. (e) An agent may not dissuade, or attempt to dissuade, a consumer from: (1) truthfully responding to an insurer's request for confirmation or suitability information; (2) filing a complaint; or (3) cooperating with the investigation of a complaint. Sec CERTIFICATION REQUIREMENTS. A person may not provide a certification under Section (c) unless the person: (1) is a senior manager with responsibility for the delegated functions; and (2) has a reasonable basis for making the certification. Sec COMPLIANCE WITH CERTAIN NATIONAL STANDARDS. (a) Subject to Subsection (c), sales made in compliance with the conduct rules of the Financial Industry Regulatory Authority (FINRA) relating to suitability and supervision of annuity transactions, or the rules of another national organization recognized by the commissioner, satisfy the requirements of this chapter. This section applies to FINRA member broker-dealer sales of variable annuities and fixed annuities if the suitability and supervision conduct rules are similar to those applied to variable annuity sales. (b) This section does not affect or limit the commissioner's ability to enforce or investigate under this chapter. (c) Subsection (a) applies only if the insurer: (1) monitors the FINRA member broker-dealer using information collected in the normal course of the insurer's business; and (2) provides to the FINRA member broker-dealer information and reports that are reasonably appropriate to assist the broker-dealer to maintain the broker-dealer's supervision system. Sec RECORDKEEPING REQUIREMENTS. (a) Each agent, independent agency, and insurer shall maintain, or otherwise be able to make available to the commissioner, records of the information collected from the consumer and other information used in making a recommendation that was the basis for a transaction subject to this chapter until the fifth anniversary of the date on which the transaction is completed by the insurer. (b) An insurer may, but is not required to, maintain documentation on behalf of an agent. (c) Records required to be maintained under this section may be maintained in paper, photographic, microprocess, magnetic, mechanical, or electronic media by any process that accurately reproduces the actual document. Sec AGENT TRAINING REQUIREMENTS. (a) An agent may not solicit the sale of an annuity product unless the agent has adequate knowledge of the product to recommend the annuity and is in compliance with the insurer's standards for product training. An agent may rely on insurer-provided, product-specific training standards and materials to comply with this subsection. (b) An agent who engages in the sale of annuity products must complete a one-time training course approved by the department and provided by a continuing education provider. (c) The training required by Subsection (b) must be of a length sufficient to qualify for at least four continuing education credits, as determined by the commissioner in accordance with Chapter 4004 and any rules adopted under that chapter, but may be longer. The training required by Subsection (b) may be used to satisfy the continuing education requirements under Subchapters B and E, Chapter 4004, and is not in addition to the continuing education requirements in Section (d) The training required by Subsection (b) must include information on the following topics: (1) the types of annuities and various classifications of annuities; (2) identification of the parties to an annuity; 4

8 (3) how fixed, variable, and indexed annuity contract provisions affect consumers; (4) the application of income taxation of qualified and nonqualified annuities; (5) the primary uses of annuities; and (6) appropriate sales practices, replacement, and disclosure requirements. (e) A provider of a course intended to comply with Subsection (b) must cover all topics listed in Subsection (d) and may not present any marketing information, provide training on sales techniques, or provide specific information about a particular insurer's products. Additional topics may be offered in conjunction with and in addition to the required topics. (f) A provider of a course intended to comply with Subsection (b) must register as a continuing education provider in this state and comply with the rules and guidelines applicable to agent continuing education courses provided by Chapter (g) An annuity training course may be conducted and completed by classroom or self-study methods in accordance with Chapter (h) A provider of annuity training under Subsection (b) must comply with the reporting requirements and issue certificates of completion in accordance with Chapter (i) The satisfaction of the training requirements of another state that are substantially similar to the provisions of this section is considered to satisfy the training requirements of this section. (j) An insurer must verify that an agent has completed the annuity training course required by this section before allowing the agent to sell an annuity product for that insurer. An insurer may satisfy the insurer's responsibility under this section by: (1) obtaining a certificate of completion of the training course or obtaining an appropriate report provided by the department; (2) using a department-sponsored database or vendor; or (3) using a reasonably reliable commercial database vendor that has a reporting arrangement with approved insurance education providers. Sec MITIGATION. An insurer is responsible for compliance with this chapter. If a violation occurs because of the action or inaction of the insurer or the insurer's agent, the commissioner may: (1) order: (A) the insurer to take reasonable appropriate corrective action for any consumer harmed by the insurer or by the insurer's agent because of a violation of this chapter; or (B) a general agency, independent agency, or the agent to take reasonably appropriate corrective action for any consumer harmed by the agent's violation of this chapter; and (2) impose appropriate sanctions as provided by Section Sec SANCTIONS. (a) The commissioner may impose sanctions as provided by Chapter 82 for a violation of this chapter. (b) The commissioner shall reduce or eliminate a sanction for a violation of this chapter otherwise applicable if: (1) corrective action for the consumer was taken promptly by the agent or insurer after a violation was discovered; or (2) the violation was not part of a pattern or practice. SECTION 20. This Act takes effect September 1,

9 ANNUITY SUITABILITY QUESTIONNAIRE FOR ALL APPLICANTS (Please attach additional sheets as necessary) This questionnaire is designed to elicit information about your financial needs and investment objectives so that your agent can determine which product, if any, is suitable for you. Completion of this entire suitability questionnaire is mandatory. The Company uses this form to help monitor the suitability of annuity sales for the benefit of the customer. Joint Owners: In the instance of joint ownership, the Company assumes that all responses are the same for both individuals if the relationship is spousal. If not spousal, separate questionnaires must be completed by each joint owner. Trusts as Owners: See page 5 for instructions on completing this questionnaire for trust-owned annuities. Name of Owner/Applicant Age Date of Birth Name of Joint Owner/Applicant (if applicable) Age Date of Birth Product Name Withdrawal Charge Period Premium Amount FINANCIAL SITUATION AND NEEDS 1. Annual income: $0-$24,999 $25,000-$49,999 $50,000-$99,999 $100,000-$249,999 $250, ,999 $500,000-$999,999 $1,000,000 or higher 2. Sources of income (please enter the percentage of your income attributed to each of the categories below, if applicable): % Salary % Investments % Retirement Plan/Pension Plan % Social Security % Other: 3. Federal Tax Bracket: 10% 15% 25% 28% 33% 35% or higher 4. Approximate Net Worth ( Net Worth means your total assets (including the premium for this annuity, but excluding primary residence or personal property, such as jewelry, furnishings, and vehicles) less your total debts (excluding mortgages on primary residence)): $0-$24,999 $25,000-$49,999 $50,000-$99,999 $100,000-$249,999 $250,000-$499,999 $500,000-$999,999 $1,000,000 or higher 5. What are the financial resources used for the funding of this annuity? (please select all that apply) Annuity* Life Insurance* Certificates of Deposit Savings/checking Account Reverse Mortgage/Home Equity Loan Other investments* *Please Note: If the source of funds is from an annuity contract, life policy, or investment account, please submit your most recent account statement from that policy/contract along with your NWL application. DM-1174.Rev.6.11 Page 1 of 5

10 INTENDED USE OF THIS ANNUITY 6. What are your financial objective(s) in purchasing this annuity? (please select all that apply) Growth for Future Tax Deferral Save for Emergencies General Savings Retirement Income Estate Planning Immediate Income Safety of Principal Other 7. How do you anticipate taking distributions from this annuity? (please select all that apply) Annuitization Single lump sum 10% Penalty-Free Withdrawals Systematic Interest Withdrawals Partial surrenders Loans Leave to beneficiary RMDs Lifetime Withdrawal Payments through Withdrawal Benefit Rider 8. How will contract values, if any, be paid at death? (select one) Payments to beneficiary over a period of five or more years Payment to beneficiary in a single lump sum LIQUIDITY NEEDS AND FINANCIAL TIME HORIZON 9. What is your Liquid Net Worth after the purchase of this annuity? ( Liquid Net Worth means the value of all of your liquid assets, which are assets that could readily convert to cash without imposition of fees or penalties.) $0-$24,999 $25,000-$49,999 $50,000-$99,999 $100,000-$249,999 $250,000-$499,999 $500,000-$999,999 $1,000,000 or higher 10. Do you have sufficient available cash, liquid assets, or other sources of income for living expenses, health care, and emergencies after the purchase of this annuity? Yes No 11. Do you anticipate any significant changes in your household s income, living expenses, or liquid assets during the surrender charge period of the annuity being purchased? Yes No (For example, do you expect a reduction in income caused by retirement or pension changes or by an increase in expenses such as housing, medical, nursing home, assisted living, or travel expenses?) If Yes, please explain: 12. How long do you plan to keep this annuity (i.e., what is your financial time horizon)? (select one) 1-3 Years 4-6 Years 7-9 Years Years Years 16+ Years 13. When do you anticipate taking your first distribution from this annuity? (select one) 1-3 Years 4-6 Years 7-9 Years Years Years 16+ Years FINANCIAL EXPERIENCE 14. Rate your investment knowledge (select one): Limited Average Extensive 15. Rate your risk tolerance (select one): Conservative Moderate Aggressive 16. What other financial products do you own or have you previously owned? (please select all that apply) None Certificates of Deposit Fixed annuities Variable annuities Stocks/bonds/mutual funds Other (please list) _ 17. What is the total amount of your existing assets, including investment and life insurance holdings? $0-$24,999 $25,000-$49,999 $50,000-$99,999 $100,000-$249,999 $250,000-$499,999 $500,000-$999,999 $1,000,000 or higher DM-1174.Rev.6.11 Page 2 of 5

11 EXCHANGE OR REPLACEMENT 18. Is this an exchange or replacement of an annuity or life contract? Yes No If yes, please proceed. If no, please skip to question 19. Type of product being exchanged/replaced (e.g., fixed, fixed indexed, variable annuity) Company Name (e.g., ABC company) Product Name (if applicable) Purchase Date Surrender Value (account value less surrender charge of the product being exchanged/replaced) Surrender Charge (total dollar amount) Example: Fixed Annuity ABC Company Indexer $23,000 $ a) As a result of this transaction, will you lose any existing benefits, experience any tax consequences, or be subject to increased fees or charges for riders or other product enhancements in proceeding with this exchange/replacement? Yes No If yes, please explain: b) Please explain how you will benefit from this annuity s enhancements and improvements compared to the contract you are exchanging/replacing: c) Have you had another annuity exchange or replacement (excluding this one)? Yes within the last 36 months Yes more than 36 months ago No If yes, please explain: ADDITIONAL INFORMATION 19. Do you (or the trust beneficiary/grantor/settlor if a trust is the owner) currently reside in a nursing home or assisted living facility or plan to enter a nursing home or assisted living facility in the next 6 months? Yes No If yes, please explain: 20. Do you understand and accept that you could possibly lose some of your principal if you surrender your policy early during the withdrawal charge period (if your cash surrender value is less than your premium)? Yes No 21. Do you understand and accept that your interest credits will fluctuate depending on the product you are purchasing and, if applicable, the strategy allocation you have selected? Yes No 22. What other information, if any, do you consider material in deciding to purchase this annuity? Please explain: DM-1174.Rev.6.11 Page 3 of 5

12 NOTE: If this form is not completed, signed, and dated, we cannot consider your application. AGENT CERTIFICATION Explain why you have reasonable grounds for believing that the annuity that you recommended is suitable for the owner/applicant, including how he/she will benefit from the purchase of this annuity: _ By signing below, I certify that I have reasonable grounds for believing that my recommendation is suitable on the basis of facts disclosed by the owner/applicant as to financial situation and needs, investments, and other insurance products, and I realize that National Western may issue this annuity in reliance on my recommendation. Agent Signature Agent Address ( to be used for communication regarding suitability) _ Date _ Annuity Agent Number OWNER/APPLICANT CERTIFICATION By initialing beside each statement and signing below, I certify to the following: I have reviewed the Consumer Information Summary and Disclosure brochure that pertains to this annuity with my agent, and I have been reasonably informed of the various features of this annuity, including but not limited to the withdrawal charge period, withdrawal charges, charges for riders, and limitations on interest returns, before deciding to purchase this annuity. I have discussed my current financial and insurance products with my agent before deciding to purchase this annuity. I understand that if I am exchanging or replacing an existing annuity, I may incur surrender charges/fees and that I may not be able to reinstate this replaced contract; however, I believe this transaction to be in my best interest. I understand that if I take money out of this product in excess of the free withdrawal amount provided in the contract during the withdrawal charge period, I will incur a withdrawal charge. I understand that my agent will receive compensation/commission as a result of this transaction. I have reviewed this Annuity Suitability Questionnaire, and I understand its contents. I understand that National Western is relying on the information that I have provided on this questionnaire, and I certify that it is complete and accurate to the best of my knowledge. I have undergone a thorough discussion with my agent regarding the suitability of this annuity, and I certify that it is suitable for my circumstances. Owner/Applicant/Trustee Signature Joint Owner/Applicant/Co-Trustee Signature (if applicable) _ Date _ Date DM-1174.Rev.6.11 Page 4 of 5

13 Instructions for Trusts as Owners In instances in which a trust will be the owner of an annuity, the Company has specific requirements regarding what information must be captured on the Annuity Suitability Questionnaire. Please use the charts below to determine how the questionnaire(s) must be completed and what information needs to be included. In some instances more than one questionnaire is required. In addition, please note the following: For multiple trustees who must act together, the Annuity Suitability Questionnaire must be signed by all trustees. Be sure to complete and submit the Trust Information Form (DM-1094). Revocable Trusts If: Then: The Grantor/Settlor and Trustee are the SAME The grantor/settlor of the Trust must complete the Suitability Questionnaire as to his/her own personal information If there are multiple non-spousal grantors/settlors, a separate Suitability Questionnaire must be completed for each grantor/settlor The trustee(s) must complete the entire Suitability Questionnaire with the Trust s information (net worth, goals, objectives, etc.) including the following modifications: The Grantor/Settlor and Trustee are DIFFERENT For Name of Owner/Applicant, enter the name of the trust; For Age, enter N/A ; For Date of Birth, enter the date on which the trust was established; and For Owner/Applicant/Trustee Signature, the trustee must sign as trustee (e.g., Jane Doe, TTEE) Do NOT include the trustee s personal information -AND IN ADDITION- The grantor/settlor of the Trust must complete a separate Annuity Suitability Questionnaire as to his/her own personal information Irrevocable or Non-Grantor/Settlor Trusts The trustee(s) must complete the entire Suitability Questionnaire with the Trust s information (net worth, goals, objectives, etc.) including the following modifications: For Name of Owner/Applicant, enter the name of the trust; For Age, enter N/A ; For Date of Birth, enter the date on which the trust was established; and For Owner/Applicant/Trustee Signature, the trustee must sign as trustee (e.g., Jane Doe, TTEE) Do NOT include the trustee s personal information DM-1174.Rev.6.11 Page 5 of 5

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