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Improved Annuity Application and
State Replacement Forms


Required March 17, 2020


We are pleased to announce improvements to Annuity Applications used in most states, and State Replacement forms. 


Annuity Applications

The new application forms – dated 08-19 – apply to all annuity products for all states, with two exceptions:

• California – use the current Annuity Application: ANN-APP(12-16)

• Pennsylvania – for Confidence Income Annuity sales use 436-121(03-06)


State Variations – Annuity Applications
• All States, Excluding States Listed Below – ICC19-ET-APP(08-19)

• Delaware, North Dakota, South Dakota – ET-APP(08-19)

• Florida – ET-APPFL(08-19)


Transition Rules

Either the new 08-19 applications or the current applications may be used now and through the end of this month. Beginning March 17, the new 08-19 applications will be required. If you have preprinted application packets for states other than California, please replace them.


State Replacement Forms

Revised replacement forms – dated 02-20 – are also available now for all applicable annuity sales.


Available For Use Now

The new 08-19 applications and replacement forms are available now on AppBuilder and E-App


Questions? Call Sales Support
at 866-598-3694 or
visit the Agent
Website at


Products underwritten and issued by EquiTrust Life Insurance Company, West Des Moines, Iowa. Products distributed by EquiTrust Insurance Marketing Services; in California doing business as EQT Insurance Marketing Services.





7100 Westown Pkwy Suite 200
West Des Moines, IA 50266

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