Please complete all information that applies to your agreement and sign at the bottom.

I hereby apply for a one-life Gift Annuity Agreement to be issued in the name of:
(First Annuitant): ___ Mr. ___ Mrs. ___ Miss
Name: ___________________________________________________________
Address:_________________________________________________________
City/State/Zip:__________________________________________________
Telephone:______________________________
Birth Date:_____________________________
Social Security No:_____________________

I am interested in a two­life agreement. I wish to designate a beneficiary to receive my annuity benefits at the time of my death. (NOTE: A two­life agreement pays a lower rate than a one­life agreement.) In the event that the second annuitant survives the first annuitant, payments will be paid to survivor for life; otherwise, annuity payments terminate upon the death of first annuitant.
(Second Annuitant): ___ Mr. ___ Mrs. ___ Miss
Name:____________________________________________________________
Address:_________________________________________________________
City/State/Zip:__________________________________________________
Telephone:______________________________
Birth Date:_____________________________
Social Security No:_____________________
Relationship to First Annuitant:_____________________

I am making this annuity gift, but I am not the first annuitant. Please complete the following:
___ Mr. ___ Mrs. ___ Miss
Name:____________________________________________________________
Address:_________________________________________________________
City/State/Zip:__________________________________________________
Telephone:______________________________
Social Security No:_____________________

In consideration for this Gift Annuity Agreement, I enclose the sum of $____________, and/or the following described securities:__________________

I would like to defer payments for 12 months or more and begin receiving payments on ___________ (Month/Year).

I request that payments be made: ___ annually ___ semiannually or ___ quarterly, on the last day of the month.

I understand that this Gift Annuity Agreement is irrevocable, that payments are backed solely by the full faith and credit of the Christ Temple Church of the Apostolic Faith Inc., and that payments are not insured or guaranteed by any government entity.

Donor's Signature____________________________________ Date _______________________