Okla. Stat. tit. 36, § 36-4036
This is the official text of Okla. Stat. tit. 36, § 36-4036, part of Oklahoma’s Stat. tit. 36, — part of the compiled statutory law of Oklahoma, published by the state as "Stat. tit. 36,." Browse the sections below, each linked to its official government source.
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Statement by applicant regarding notification of
Official statutory text
replacement to replaced insurer.
The statement referred to in the Life Insurance and Annuity
Policyholders Protection Act shall be delivered to the applicant for
a replacement life insurance policy or a replacement annuity policy
along with the notice provided for in Section 5 of the Life
Insurance and Annuity Policyholders Protection Act. The legal name
and address of the replacing insurer may be printed on the
statement. Said statement shall be in substance as follows:
STATEMENT BY APPLICANT REGARDING NOTIFICATION
OF REPLACEMENT TO THE REPLACED INSURER
I have read the "NOTICE TO APPLICANTS REGARDING REPLACEMENT OF
LIFE INSURANCE OR AN ANNUITY" which was furnished to me by the agent
taking the application for this policy.
(Applicant: Please sign ONE of the following statements.)
1. Please notify my present insurer(s) regarding this
transaction.
_______________________
_______________________
_
Date Signature of Applicant
2. Please do not notify my present insurer(s) regarding this
transaction.
_______________________ ________________________
Date Signature of
Applicant
The signature of the applicant shall be that of the insured
unless someone other than the insured is the owner of the policy. If
Oklahoma Statutes - Title 36. Insurance Page 862
someone other than the insured is the owner of the policy, the owner
must sign. If the insured is under eighteen (18) years of age, the
parent is deemed to be the owner of the policy.
Certification by the agent:
I hereby certify that nothing was said or done during the sales
presentation to influence the decision of the applicant regarding
this statement.
________________________ _______________________
Date Signature of Agent
__________________________
Insurance Agency or Agent
License Number
The statement referred to in the Life Insurance and Annuity
Policyholders Protection Act shall be delivered to the applicant for
a replacement life insurance policy or a replacement annuity policy
along with the notice provided for in Section 5 of the Life
Insurance and Annuity Policyholders Protection Act. The legal name
and address of the replacing insurer may be printed on the
statement. Said statement shall be in substance as follows:
STATEMENT BY APPLICANT REGARDING NOTIFICATION
OF REPLACEMENT TO THE REPLACED INSURER
I have read the "NOTICE TO APPLICANTS REGARDING REPLACEMENT OF
LIFE INSURANCE OR AN ANNUITY" which was furnished to me by the agent
taking the application for this policy.
(Applicant: Please sign ONE of the following statements.)
1. Please notify my present insurer(s) regarding this
transaction.
_______________________
_______________________
_
Date Signature of Applicant
2. Please do not notify my present insurer(s) regarding this
transaction.
_______________________ ________________________
Date Signature of
Applicant
The signature of the applicant shall be that of the insured
unless someone other than the insured is the owner of the policy. If
Oklahoma Statutes - Title 36. Insurance Page 862
someone other than the insured is the owner of the policy, the owner
must sign. If the insured is under eighteen (18) years of age, the
parent is deemed to be the owner of the policy.
Certification by the agent:
I hereby certify that nothing was said or done during the sales
presentation to influence the decision of the applicant regarding
this statement.
________________________ _______________________
Date Signature of Agent
__________________________
Insurance Agency or Agent
License Number
Status: in_force · Read it on the official government site
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