Notice To Owner Regarding Replacement Of Life Insurance Page 4
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7Comparative Information Form for
Existing Insurance
Exhibit B
(Complete if Owner’s initials are present in “YES” box on Exhibit A AND
existing policy is a MassMutual, C.M. Life, or MML BayState product.)
MUST BE PRESENTED TO, SIGNED AND DATED BY THE OWNER AND PRODUCER AT THE TIME OF APPLICATION
Existing Insurer: _________________________________________________________________________________________________
Insurer’s Address: ________________________________________________________________________________________________
O O W W N N E E R R I I N N F F O O R R M M A A T T I I O O N N : :
P P O O L L I I C C Y Y I I N N F F O O R R M M A A T T I I O O N N : :
Policy Generic Name ___________________________________
Name _______________________________________________
Policy Number ________________________________________
Address _____________________________________________
Date of Issue _________________ Issue Age _______________
____________________________________________________
Contestable Period Expires _____________________________ __
Telephone (
) ____________________________________
Suicide Period Expires __________________________________
Date of Birth ________________________ Age _____________
Policy Loan Rate _______________________________________
P P O O L L I I C C Y Y / / R R I I D D E E R R D D E E S S C C R R I I P P T T I I O O N N :
Initial/
(Age) Benefit
Initial/Renewal
(Age) Payable
Policy/Rider Name
Continuing Benefit
From
To
Annual Premium
From
To
Total Initial Annual Premium $ ___________________ Mode of Payment ____________________ Amount $ ____________________
Total Renewal Annual Premium $ ___________________ Mode of Payment ___________________ Amount $ __________________
F5436FL REV. 807
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