Insurance Agent Disclosure Form Now Required with New Apps

Effective June 17, 2023, Nassau is changing its new business process to now require the completed “Insurance Agent/Producer Disclosure for Annuities” form with all new annuity applications submitted in states where this form is required. The form has been seamlessly added to our eApp process. For paper submissions, producers will be required to include the form with their application materials.

As part of this change, Nassau’s Suitability Questionnaire forms will also be updated and producers will no longer be required to acknowledge that this disclosure has been signed by the applicant(s).

For your convenience, below is a map showing the states which have adopted the latest NAIC Model Reg 275 (or a version thereof) and where Nassau will require the Insurance Agent/Producer Disclosure for Annuities (Appendix A) form to be included with applications. We appreciate your commitment to complying with these regulatory requirements.

State details valid as of January 1, 2024. Utah effective July 1, 2024. For informational purposes only. Not intended as legal advice.

*Separate from Reg 275, Regulation 187 creates a suitability and best interest standard for life and annuity products sold in the state of New York.

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Our sales team is ready and available to assist you. Call us for illustrations, product expertise, and marketing materials at 1-888-794-4447.


For Producer Use Only. Not for distribution to the public.

Products, rider options and other features are subject to state availability. Actual product details, including all terms and conditions that apply, are contained in the annuity contract. Product sales must be appropriate based on a comprehensive evaluation of the customer’s financial situation, insurance needs, and objectives. Guarantees are based on the claims-paying ability of the issuing company.

Nassau, its affiliated companies, and employees do not give fiduciary, legal or tax advice.

Annuities are issued by Nassau Life and Annuity Company (Hartford, CT) except in New York where annuities are issued by Nassau Life Insurance Company (East Greenbush, NY). In California, Nassau Life and Annuity Company does business as “Nassau Life and Annuity Insurance Company”. Nassau Life and Annuity Company is not authorized to conduct business in ME and NY, but that is subject to change. Nassau Life and Annuity Company and Nassau Life Insurance Company are subsidiaries of Nassau Financial Group.

Insurance Products: NOT FDIC or NCUAA Insured | NO Bank or Credit Union Guarantee.


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Anthony LaRosaInsurance Agent Disclosure Form Now Required with New Apps