Switch Disclosure Form - cri4.com

1 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 $ (iv) Annual fund Operating Expense as outlined in the prospectus.

2 Total Exp. Rate including VA (sub-accounts) and Qualified Plans. If none, please indicate zero or N/A under fund Expense Percent. Amount of Invested Dollars fund Expense Percent Approximate Annual Operating Expense Dollar Amount fund Name: fund Name: fund Name: fund Name: fund Name: fund Name: $ $ $ $ $ $ % % % % % % $ $ $ $ $ $ 2. Provide Detailed Explanation for the Switch or Replacement: 3. This Switch is: My/Our decision Recommended by my/our Registered Representative/Investment Advisor Representative I/We request the proceeds from my/our existing investment product (s) or 401(k) Plan to be applied to my/our new purchase of the following investment product : 4.

3 New Investment product Company Name product Name MF VA VUL Other Share Class Dollar Amount $ 1035 Exchange Yes No (i) My/Our new investment may incur a front-end charge of (%) as outlined in the prospectus, representing approximately ($) / N/A (ii) Annual fund Operating Expense as outlined in the prospectus. Total Exp. Rate including VA (sub-accounts) and Qualified Plans. If none, please indicate zero or N/A under fund Expense Percent. Amount of Invested Dollars fund Expense Percent Approximate Annual Operating Expense Dollar Amount fund Name: fund Name: fund Name: fund Name: fund Name: $ $ $ $ $ % % % % % $ $ $ $ $ 5.

4 Client Initials: Annuity to Annuity Exchange Joint Client Initials: If I am surrendering an annuity to purchase another annuity I have been provided an Annuity Nexus Comparison of both products. Rev. April 2017 2 of 3 6. Client Initials: I/We understand that effective January 1, 2015, only one rollover can be done per year per IRS Announcement 2014-32. This is my/our only IRA to IRA Rollover for this year. Joint Client Initials: 7. Client Initials: Money Market- I/we understand that switching from my/our existing investment into a Money Market for potential reinvestment into another product at a future date may incur a maximum sales charge of % for my/our future purchase. Joint Client Initials: 8.

5 Client Initials: If recommended by my/our Representative, I/we understand that my/our Representative may receivecompensation in connection with this transaction and that I/we are not obligated to Switch Client Initials: 9. Client Initials: I/We understand there is no guarantee that the new investment will perform better than my/ourexisting product being Client Initials: 10. Client Initials: I/We understand that I/we may incur a tax liability; I/We understand that my Representatives does not give tax advice and it is my/our obligation to seektax advise independently;Joint Client Initials: Distributions taken from qualified plans prior to age 59 will generally be subject to a 10% Client Initials: If I/We decide to liquidate/surrender the new investment product prior to the end of theCDSC/surrender period, which is years, I/we may incur a CDSC or a surrender charge declining to zero (determined by length of time investment held) as outlined in the prospectus.

6 Joint Client Initials: 12. Client Initials: I/We understand that expense factors in a variable annuity and variable universal life may be higherthan expenses charged in a mutual Client Initials: 401(k) Plan Assets 13. Client Initial The following options have been discussed with me regarding assets from my employer sponsored 401(k) Plan. Leave assets in former 401(k) Plan, if permitted; Rollover assets to new 401(k) Plan, if possible; Rollover assets to an IRA; Cash out the account mindful of tax consequences for those under age 59 ;I am aware that each option offers advantages and disadvantages, depending on desired investment options, services, fees and expenses, withdrawal options, required minimum distributions, tax consequences and my unique financial needs and retirement plans.

7 Additionally, I acknowledge that there are different levels of service available under each option, , access to investment advice, planning tools, telephone help line, educational material and workshops. Similarly, IRA providers offer different levels of service, which may include full brokerage service, investment advice, distribution planning and access to securities execution online. Rev. April 2017 3 of 3 14. Client Initial Conflict of Interest - Fees and Expenses I am aware that rolling over 401(k) Plan assets to an IRA may earn commissions or cause other fees for theRegistered Representative/Investment Advisor Representative; Additionally, I am aware that 401(k) Plans and IRAs typically involve (i) investment-related expenses and (ii)plan or account fees; Investment-related expenses may include sales loads, commissions and the expense of any mutual fund inwhich assets are invested and investment advisory fees.

8 Plan fees typically include but are not limited to: plan administrative fees and fees for services such as access to a Customer Service Client Initial Penalty-Free Withdrawals and Required Minimum distributions I have compared the costs of IRA and 401(k) Plan withdrawals and loans, using the before and after age 59 threshold. Additionally, I understand that those employed at age 70 are not subject to the requiredminimum distribution (RMD) from the 401 (k) Plan of a current employer, potentially letting assets earnlonger. This may be advantageous if I plan to work into my Client Initial Protection From Creditors and Legal Judgments I understand that 401(k) Plan assets have unlimited protection from creditors under federal law, while IRA assets are protected in bankruptcy proceeding only and State IRA laws Client Initial Employer Stock I understand that there may be negative tax consequences of rolling significantly appreciated employer stockfrom a 401(k) Plan to an IRA.

9 If transferred in-kind, stock appreciation will be taxed as ordinary income : IMPORTANT THIS Disclosure form MUST BE COMPLETED IN ITS ENTIRETY DO NOT SIGN THIS form IF YOU DO NOT UNDERSTAND THIS TRANSACTION OR IF THIS form CONTAINS BLANKS Customer Signature: Date: Joint Customer Signature: Date: Registered Representative/Investment Advisor Representative: By signing below, you confirm that you have disclosed the fees and charges involved with this transaction and provided your customer(s) with a current prospectus. Print Representative Name: Representative Signature: Date: INTERNAL USE ONLY Branch Office and Internal Use Only By signing below, you consider this transaction to be suitable based on the information contained herein and other required transaction documentation.

10 Print Branch Office Manager Name: Branch Office Manager Signature: Date: Print Home Office OSJ Principal Name: Home Office OSJ Principal Signature: Date.