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Please fill out this form and mail it and send it to us by clicking submit at the bottom of this form. The information you provide does not obligate you in any way to contribute for a gift annuity. It will simply allow KRCB to prepare an annuity illustration for you. The illustration will show the amount of annuity payments you would receive and the tax benefits available to you.

Please indicate approximate cost basis if property other than cash is to be contributed:

Names and dates of birth of annuitants (those who will receive annuity payments):


First annuitant:

Second annuitant:

Annuities are subject to regulation by the State of California. Payments under such agreements, however, are not protected or otherwise guaranteed by any government agency or the California Life and Health Insurance Guarantee Association.

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