ANNUITIES DISCLOSURE FORM
It is important to us that you understand that an annuity is different from other investments you may purchase from ______ Bank. Please consider the following factors when purchasing an annuity.
*The annuity product is an obligation of the ________________________ insurance company only. It is not an obligation of ________________________ Bank or its subsidiaries or affiliated companies.
*The annuity product is not insured by the Federal Deposit Insurance Corporation ("FDIC") or any other federal or state agency.
*Early withdrawals from your annuity may be subject to surrender charges, taxation as ordinary income, and an additional nondeductible excise tax.
You are encouraged to consult with a tax advisor familiar with your individual situation and needs in order to determine the federal, state, local and other tax consequences associated with annuities.
By signing below, you certify that you have read and understand the information contained in this disclosure.
Date: ________________________
Purchaser's Signature_______________
La. Admin. Code tit. 10, § III-343