ACORD 759TX Instructions


Section Name Field Name Field and/or Section Description
Texas Important Notice: Use ACORD 759 TX, Texas Important Notice: Replacement of Life Insuranceor
TITLE Replacement of Life Insurance or Annuities, in the state of Texas, to inform the Carrier of the intent to replace a policy. The
ACORD 759 TX (2008/02) Annuities form is to be completed by the Producer and then sent to the new Carrier.
Name and Address of Insurance Name of Insurance Company must be inserted before this form is used. Use the actual
IDENTIFICATION SECTION Company name of the company. Do not use group names.
REPLACEMENT OF LIFE INSURANCE OR ANNUITIES 1. Are you considering discontinuing making premium payments, surrendering, forfeiting, assigning to the insurer, or otherwise terminating your existing policy or contract? Answer by checking the appropriate box.
REPLACEMENT OF LIFE INSURANCE OR ANNUITIES 2. Are you considering using funds from your existing policies or contracts to pay premiums due on the new policy or contract? Answer by checking the appropriate box.
REPLACEMENT OF LIFE Indicate the name of the insurer of the existing policy or contract that is being considered
INSURANCE OR ANNUITIES Insurer Name for replacement.
REPLACEMENT OF LIFE Indicate the contract or policy number of the existing policy or contract that is being
INSURANCE OR ANNUITIES Contract or Policy # considered for replacement.
REPLACEMENT OF LIFE Indicate the name of the insured or annuitant of the existing policy or contract that is being
INSURANCE OR ANNUITIES Insured or Annuitant considered for replacement.
REPLACEMENT OF LIFE
INSURANCE OR ANNUITIES Replaced /Financed Indicate whether each policy or contract will be replaced or used as a source of financing.
REPLACEMENT OF LIFE The Existing Policy or Contract is
INSURANCE OR ANNUITIES Being Replaced Because: Indicate the reason you are contemplating replacing your current policy or contract.
APPLICANT’S
CERTIFICATION Applicant’s Signature Applicant must sign the form.
Texas Important Notice: Use ACORD 759 TX, Texas Important Notice: Replacement of Life Insurance or
TITLE Replacement of Life Insurance or Annuities, in the state of Texas, to inform the Carrier of the intent to replace a policy. The
ACORD 759 TX (2008/02) Annuities form is to be completed by the Producer and then sent to the new Carrier.
APPLICANT’S
CERTIFICATION Printed Name Print or type the full name of the applicant.
APPLICANT’S
CERTIFICATION Date Date the applicant signed the form (mm/dd/yyyy).
PRODUCER’S
CERTIFICATION Producer’s Signature Producer must sign the form.
PRODUCER’S
CERTIFICATION Printed Name Print or type the full name of the producer.
PRODUCER’S
CERTIFICATION Date Date the producer signed the form (mm/dd/yyyy).
APPLICANT’S
CERTIFICATION Applicant’s Initials Applicant must initial the form if they do not want the notice read aloud to them.