NO. 06-12 DATE: May 8, 2012

NO. 06-12 DATE: May 8, 2012 TO: FROM: SUBJECT: All Producers Licensed in Utah 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 Utah 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. Utah adopted amendments to Rule R590-230 of the Utah Administrative Code, Suitability in 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 Utah regulation into accord with a new model regulation drafted by the National Association of Insurance Commissioners (NAIC) in 2010. NEW ANNUITY SUITABILITY QUESTIONNAIRE MAY 25, 2012 COMPLIANCE DATE As a result of the new regulation in Utah, National Western has created a new Annuity Suitability Questionnaire that must be used with all annuity applicants in Utah. Effective May 25, 2012, 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 May 25, 2012, 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 Utah. For example, please note the following: You are required to obtain more extensive, detailed information from the consumer defined as suitability information under the Utah 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 Utah 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 Utah and must be completed in its entirety. (over) SH-1006.Rev.5.06

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 producer 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 producers 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 PRODUCER TRAINING REQUIREMENTS The new regulation in Utah requires that insurers establish supervision procedures that include insurance producer training and monitoring. As a result of this requirement, National Western requires that insurance producers who sell to Utah residents must complete two training components: (1) A one-time, four hour general annuity training course approved by the Department and provided by a Department-approved education provider; and (2) Product- Specific Training for National Western annuity products. 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 May 10, 2012 or after, please login to National Western s producerfriendly 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 Utah. Select your license type (Life, Annuity, and Health Insurance CE) and then scroll down and click the box to select Utah 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 May 25, 2012 Compliance Date As part of National Western s producer training requirements, an insurance producer 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 producers 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 beginning May 10, 2012.

This product-specific training program is a one 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 May 10, 2012, 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 May 25, 2012. General Annuity Training Course To Be Determined Compliance Date NAFA s continuing education partner, SuccessCE, offers Utah s NAIC Suitability in Annuity Transactions CE course, which has been approved by the Utah 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 Utah regulation to verify that you have completed the required training. If you have already completed this training requirement with another authorized provider, you may email, fax, or mail your Certificate of Completion to National Western via the following methods: 1. Email: rgenz@globalnw.com 2. Fax: (512)-719-8506 3. Mail: National Western Life Insurance Company Attn: Robin Genz Licensing Supervisor 850 East Anderson Lane Austin, Texas 78752 National Western will only accept Certificates of Completion for courses that are approved by the Utah Insurance Department for this training requirement. Please note that once a compliance date is determined, 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 that date. 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 (800-760-3434). JPP/gbm This Compliance Bulletin supersedes Compliance Bulletins 28-04, 02-05, 22-06, and 02-08.

Utah Administrative Code Insurance R590 Administration R590-230 SUITABILITY IN ANNUITY TRANSACTIONS R590-230-1. Authority This rule is promulgated pursuant to Section 31A-22-425 wherein the commissioner is to make rules to establish standards for recommendations and Subsection 31A-2-201(3)(a) wherein the commissioner may make rules to implement the provisions of Title 31A. R590-230-2. Purpose (1) The purpose of this rule is to: (a) set forth standards and procedures for recommendations to consumers that result in a transaction involving annuity products so that the insurance needs and financial objectives of consumers at the time of the transaction are appropriately addressed; and (b) require insurers to establish a system to supervise recommendations. (2) Nothing herein shall be construed to create or imply a private cause of action for a violation of this rule. R590-230-3. Scope (1) This rule shall apply to any recommendation to purchase, replace, or exchange an annuity made to a consumer by a producer, or an insurer where no producer is involved, that results in the recommended purchase or exchange. (2) Unless otherwise specifically included, this rule shall not apply to recommendations involving: (a) direct response solicitations where there is no recommendation based on information collected from the consumer pursuant to this rule; and (b) contracts used to fund: (i) an employee pension or welfare benefit plan that is covered by the Employee Retirement and Income Security Act (ERISA); (ii) a plan described by Internal Revenue Code (IRC) Sections 401(a), 401(k), 403(b), 408(k) or 408(p), as amended, if established or maintained by an employer; (iii) a government or church plan defined in IRC Section 414, a government or church welfare benefit plan, or a deferred compensation plan of a state or local government or tax exempt organization under IRC Section 457; (iv) a nonqualified deferred compensation arrangement established or maintained by an employer or plan sponsor; (v) settlements of or assumptions of liabilities associated with personal injury litigation or any dispute or claim resolution process; or (vi) formal prepaid funeral contracts. R590-230-4. Definitions In addition to the definitions in Section 31A-1-301, the following definitions shall apply for the purpose of this rule: (1) Annuity means: (a) an annuity as defined in Section 31A-1-301; and (b) a fixed annuity or variable annuity that is individually solicited, whether the product is classified as an individual or group annuity. (2) FINRA means the Financial Industry Regulatory Authority or its successor. (3) Producer includes an individual producer or agency producer. (4) Recommendation means advice provided by a producer, or an insurer where no producer is involved, to an individual consumer that results in a purchase, replacement or exchange of an annuity in accordance with that advice. 1

(5) Replacement is as defined in R590-93-3. (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. R590-230-5. Duties of Insurers and of Producers (1) 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 producer, or the insurer where no producer is involved, shall have reasonable grounds for believing that 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, and that there is a reasonable basis to believe all of the following: (a) the consumer has been reasonably informed of various features of the annuity, such as the potential surrender period and surrender charge, 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. These requirements are intended to supplement and not replace the disclosure requirements of R590-229; (b) the consumer would benefit from certain features of the annuity, such as tax-deferred growth, annuitization, or death or living benefit; (c) the particular annuity as a whole, the underlying subaccounts to which funds are allocated at the time of purchase, or exchange of the annuity, and riders and similar product enhancements, if any, are suitable, and in the case of an exchange or replacement that the transaction as a whole is suitable, for the particular consumer based on the consumer's suitability information; and (d) in the case of an exchange or replacement of an annuity the exchange or replacement is suitable including taking into consideration whether: (i) the consumer will incur a surrender charge, be subject to the commencement of a new surrender period, lose existing benefits, including death, living or other contractual benefits, or be subject to increased fees, investment advisory fee or charges for riders and similar product enhancements; (ii) the consumer would benefit from product enhancements and improvements; and (iii) the consumer has had another annuity exchange or replacement and, in particular, an exchange or replacement within the preceding 36 months. (2) Prior to the execution of a purchase, replacement, or exchange of an annuity resulting from a recommendation, a producer, or an insurer where no producer is involved, shall make reasonable efforts to obtain the consumer's suitability information. (3) Except as permitted under Subsection (4), an insurer shall not issue an annuity recommended to a consumer unless there is a reasonable basis to believe the annuity is suitable based on the consumer's suitability information. (4) (a) Except as provided under Subsection (4)(b), neither a producer nor an insurer shall have any obligation to a consumer under Subsection (1) or (3) related to any annuity transaction if: (i) no recommendation is made; (ii) a recommendation was made and was later found to have been prepared based on materially inaccurate information provided by the consumer; (iii) a consumer refuses to provide relevant suitability information and the annuity transaction is not recommended; or 2

(iv) a consumer decides to enter into an annuity transaction that is not based on a recommendation of the insurer or producer. (b) An insurer's issuance of an annuity subject to Subsection (4)(a) shall be reasonable under all the circumstances actually known to the insurer at the time the annuity is issued. (5) A producer or, where no producer is involved, the responsible insurer representative, shall at the time of sale: (a) make a record of any recommendation subject to Subsection (1); (b) obtain a customer signed statement documenting a customer's refusal to provide suitability information, if any; and (c) obtain a customer signed statement acknowledging that an annuity transaction is not recommended if a customer decides to enter into an annuity transaction that is not based on the producer's or insurer's recommendation. (6) (a) An insurer shall establish a supervision system that is reasonably designed to achieve the insurer's and its producers' compliance with this rule, including the following: (i) the insurer shall maintain reasonable procedures to inform its producers of the requirements of this rule and shall incorporate the requirements of this rule into relevant producer training manuals; (ii) the insurer shall establish standards for producer product training and shall maintain reasonable procedures to require its producers to comply with the requirements of Section R590-230-6; (iii) the insurer shall provide product specific training and training materials that explain all material features of its annuity products to its producers; (iv) the insurer shall maintain procedures for review of each recommendation prior to issuance of an annuity that are designed to ensure that there is a reasonable basis to determine that a recommendation is suitable. Such review procedures may apply a screening system for the purpose of identifying selected transactions for additional review and may be accomplished electronically or through other means including physical review. Such an electronic or other system may be designed to require additional review only of those transactions identified for additional review by the selection criteria; (v) the insurer shall maintain reasonable procedures to detect recommendations that are not suitable. This may include confirmation of consumer suitability information, systematic customer surveys, interviews, confirmation letters and programs of internal monitoring. Nothing in this subsection prevents an insurer from complying with this subsection by applying sampling procedures, or by confirming suitability information after issuance or delivery of the annuity; and (vi) the insurer shall annually provide a report to 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 corrective action taken or recommended, if any. (b) (i) Nothing in this subsection restricts an insurer from contracting for performance of a function, including maintenance of procedures, required under Subsection (6)(a). An insurer is responsible for taking appropriate corrective action and may be subject to sanctions and penalties pursuant to Section R590-230-7 regardless of whether the insurer contracts for performance of a function and regardless of the insurer's compliance with Subsection (6)(b)(ii). (ii) An insurer's supervision system under Subsection (6)(a) shall include supervision of contractual performance under this Subsection. This includes the following: (a) monitoring and, as appropriate, conducting audits to assure that the contracted function is properly performed; and (b) annually obtaining a certification from a senior manager, who has responsibility for the contracted functions that the manager has a reasonable basis to represent, and does represent, that the function is properly performed. (iii) An insurer is not required to include in its system of supervision a producer's recommendations to consumers of products other than the annuities offered by the insurer. (7) A producer shall not dissuade, or attempt to dissuade, a consumer from: (a) truthfully responding to an insurer's request for confirmation of suitability information; (b) filing a complaint; or (c) cooperating with the investigation of a complaint. (8) (a) Sales made in compliance with FINRA requirements pertaining to suitability and supervision of annuity transactions shall satisfy the requirements under this rule. This subsection applies to FINRA broker-dealer sales of variable annuities and fixed annuities if the suitability and supervision is similar to those applied to variable annuity sales. However, nothing in this 3

subsection shall limit the commissioner's ability to enforce, including investigate, the provisions of this rule. (b) For Subsection (8)(a) to apply, an insurer shall: (i) monitor the FINRA member broker-dealer using information collected in the normal course of an insurer's business; and (ii) provide to the FINRA member broker-dealer information and reports that are reasonably appropriate to assist the FINRA member broker-dealer to maintain its supervision system. R590-230-6. Producer Training A producer may not solicit the sale of an annuity product unless the producer has adequate knowledge of the product to recommend the annuity and the producer is in compliance with the insurer's standards for product training. R590-230-7. Compliance Mitigation and Penalties (1) An insurer is responsible for compliance with this rule. If a violation occurs, either because of the action or inaction of the insurer or its producer, the commissioner may order: (a) an insurer to take reasonably appropriate corrective action for any consumer harmed by the insurer's, or by its producer's, violation of this rule; (b) a producer to take reasonably appropriate corrective action for any consumer harmed by the producer's violation of this rule; and (c) appropriate penalties and sanctions. (2) Any applicable penalty under 31A-2-308 for a violation of this rule may be reduced or eliminated if corrective action for the consumer was taken promptly after a violation was discovered or the violation was not part of a pattern or practice. R590-230-8. Records Insurers and producers shall maintain or be able to make available to the commissioner records of the information collected from the consumer and other information used in making the recommendations that were the basis for insurance transactions for the current calendar year plus three years after the insurance transaction is completed by the insurer. An insurer is permitted, but shall not be required, to maintain documentation on behalf of a producer. R590-230-9. Enforcement Date The commissioner will begin enforcing the provisions of this rule 60 days from the rule's effective date. R590-230-10. Severability If any provision of this rule or the application of it to any person or circumstance is for any reason held to be invalid, the remainder of the rule and the application of the provision to other persons or circumstances shall not be affected by it. 4

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 NWL Product Name Withdrawal Charge Period Premium Amount FINANCIAL SITUATION AND NEEDS 1. Annual income: Provide Amount $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 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.11.11 Page 1 of 5

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% (or cumulative) Penalty-Free Withdrawals RMDs Partial surrenders Loans Leave to beneficiary Systematic Interest Withdrawals 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.) Provide Amount $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 10-12 Years 13-15 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 10-12 Years 13-15 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 Reverse Mortgage Stocks/bonds/mutual funds Other (please list) _ 17. What is the total amount of your existing assets, including investment and life insurance holdings, remaining after the purchase of this annuity? $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.11.11 Page 2 of 5

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) Example: Indexed 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) Remaining Surrender Period ABC Company Indexer 2000 3-16-07 $23,000 $230.00 2 Years 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 60 months Yes within the last 36 months Yes more than 60 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.11.11 Page 3 of 5

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 Email Address (Email 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.11.11 Page 4 of 5

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.11.11 Page 5 of 5