Switch Disclosure Form - cri4.com

Rev. April 2017 1 of 3 Switch Disclosure form To be completed when proceeds of a current product are intended for reinvestment (including Mutual Funds, Annuities, Life Insurance and Advisory business). Note: If you have more than one product please provide an additional page one. I, (customer name) /we, (joint customer name) wish to liquidate my/our current position(s) of the following: 1. Existing Investment product **Most recent investment statement required** Purchased From Current Rep Yes No Company Name product Name Type Share Class Dollar Amount $ Held For How Long (i) Subject To CDSC (Contingent Deferred Sales Charge) Yes No % Representing Approximately $ (ii) Subject To Surrender Charge Yes No % Representing Approximately $ (iii) CD: Subject To Early Withdrawal Interest Charge Yes No % Representing Approximately $

Rev. April 2017 1 of 3 Switch Disclosure Form To be completed when proceeds of a current product are intended for reinvestment (including Mutual Funds, Annuities, Life Insurance and Advisory business).

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