Annuity Application

Applicant's Information

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Country
  • Afghanistan
  • Albania
  • Algeria
  • American Samoa
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  • Antarctica
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  • Belize
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  • Central African Republic
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  • Congo, The Democratic Republic of the
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  • French Southern Territories
  • Gabon
  • Gambia
  • Georgia
  • Germany
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  • Greenland
  • Grenada
  • Guadeloupe
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  • Guernsey
  • Guinea
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  • Hong Kong
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  • Republic of Korea
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  • Luxembourg
  • Macao
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  • Madagascar
  • Malawi
  • Malaysia
  • Maldives
  • Mali
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  • Marshall Islands
  • Martinique
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  • Mauritius
  • Mayotte
  • Mexico
  • Federated States of Micronesia
  • Moldova, Republic of
  • Monaco
  • Mongolia
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  • Morocco
  • Mozambique
  • Myanmar
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  • Nauru
  • Nepal
  • Netherlands
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  • New Zealand
  • Nicaragua
  • Niger
  • Nigeria
  • Niue
  • Norfolk Island
  • Northern Mariana Islands
  • Norway
  • Oman
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  • Palau
  • Palestinian Territory, Occupied
  • Panama
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  • Paraguay
  • Peru
  • Philippines
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  • Poland
  • Portugal
  • Puerto Rico
  • Qatar
  • Reunion
  • Romania
  • Russian Federation
  • Rwanda
  • Saint Helena
  • Saint Kitts and Nevis
  • Saint Lucia
  • Saint Pierre and Miquelon
  • Saint Vincent and the Grenadines
  • Samoa
  • San Marino
  • Sao Tome and Principe
  • Saudi Arabia
  • Senegal
  • Serbia
  • Seychelles
  • Sierra Leone
  • Singapore
  • Slovakia
  • Slovenia
  • Solomon Islands
  • Somalia
  • South Africa
  • South Georgia and the South Sandwich Islands
  • Spain
  • Sri Lanka
  • Sudan
  • Suriname
  • Svalbard and Jan Mayen
  • Eswatini
  • Sweden
  • Switzerland
  • Syrian Arab Republic
  • Taiwan
  • Tajikistan
  • Tanzania, United Republic of
  • Thailand
  • Timor-Leste
  • Togo
  • Tokelau
  • Tonga
  • Trinidad and Tobago
  • Tunisia
  • Turkey
  • Turkmenistan
  • Turks and Caicos Islands
  • Tuvalu
  • Uganda
  • UK
  • Ukraine
  • United Arab Emirates
  • United States
  • United States Minor Outlying Islands
  • Uruguay
  • Uzbekistan
  • Vanuatu
  • Venezuela
  • Vietnam
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  • Virgin Islands, U.S.
  • Wallis and Futuna
  • Western Sahara
  • Yemen
  • Zambia
  • Zimbabwe
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  • Married
  • Single
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  • Common Law
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Beneficiary Information

Income and Expenses

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  • SS Income
  • Pension
  • Business Income
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Financial Information needed to determine Suitability, Net Worth and Liquid Assets. Annuity company uses this information to determine if this account will be approved. Please enter dollar amount for each account.

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New Annuity Account Information

  • Conservative
  • Moderate
  • Aggressive
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  • Single
  • Head of Household
  • Married Filing Jointly
  • Married Filing Seperately
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