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REQUEST FOR DUPLICATE POLICY Please check the box next to your Insurance Companies (Company) name. Q Manhattanville Insurance and Annuity Company q Western United Life q Manhattan Life q Family LifeInstructions:

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How to fill out nonguaranteed charges or benefits

01

Review the terms and conditions of the insurance policy or financial contract to understand what is included in nonguaranteed charges or benefits.

02

Keep track of any additional fees or charges that are not guaranteed and may depend on certain conditions or factors.

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What is nonguaranteed charges or benefits?

Nonguaranteed charges or benefits are fees or benefits in an insurance policy that are not guaranteed and may vary based on certain factors.

Who is required to file nonguaranteed charges or benefits?

Insurance companies are required to file nonguaranteed charges or benefits.

How to fill out nonguaranteed charges or benefits?

Nonguaranteed charges or benefits can be filled out by submitting the necessary forms and documentation to the appropriate regulatory body.

What is the purpose of nonguaranteed charges or benefits?

The purpose of nonguaranteed charges or benefits is to provide transparency to policyholders about potential fluctuations in fees or benefits.

What information must be reported on nonguaranteed charges or benefits?

Information such as the factors influencing the variability of charges or benefits, historical data on past variations, and the methodology used to calculate these charges or benefits must be reported.

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