Insurance Agent (Producer) Disclosure for Annuities

Do not sign unless you have read and understand the information in this form

Today's Date

First name

Last name

Business/Agency Name

Website

Business Mailing Address

Business Telephone Number

Email

National Produce Number in (State)

What types of products can I sell you?

I am licensed to sell annuities to you in accordance with state law. If I recommend that you buy an annuity, it means I believe that it effectively meets your financial situation, insurance needs, and financial objectives. Other financial products, such

Fixed or fixed indexed annuities

Variable annuities

Life Insurance

I need a separate license to provide advice about or to sell non-insurance financial products. I have checked below any non-insurance financial products that I am licensed and authorized to provide advice about or to sell.

Mutual Funds

Stocks/bonds

Certificates of deposit

Whose annuities can I sell you?

I am authorized to sell:

Annuities from only one insurer

Annuities from two or more insurers

Annuities from two or more insurers although I primarily sell annuities (list below)

Additional insurers I sell annuities from

How am I paid for my work

It’s important for You to understand how I’m paid for my work. Depending on the particular annuity You purchase, I may be paid a commission or a fee. Commissions are generally paid to me by the insurance company while fees are generally paid to me by the consumer. If You have questions about how I’m paid, please ask me.

Multi choice

Commission, which is usually paid by the insurance company or other sources. If other sources, describe:

Fees (such as a fixed amount, an hourly rate, or a percentage of your payment), which are usually paid directly by the customer

Other, describe

Additional information

If you have questions about the above compensation I will be paid for this transaction, please ask me.

I may also receive other indirect compensation resulting from this transaction (sometimes called “non-cash”compensation), such as health or retirement benefits, office rent and support, or other incentives from the insurance company or other sources.

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I declare that the info I’ve provided is accurate and complete.

Solutions LLC

Insurance Agent (Producer) Disclosure for Annuities

What types of products can I sell you?

Whose annuities can I sell you?

How am I paid for my work

Solutions LLC