SAMPLE GIFT ANNUITY APPLICATION

I enclose a contribution for the purchase of a Charitable Gift Annuity from The Vermont Community Foundation. I intend this to be an irrevocable gift

The Foundation is to pay me during my lifetime a life annuity or annual sum equal to ___% of the value of the initial gift.

Name:_______________________________________________

Legal Residence:___________________________________

Date of Birth:_________Social Security Number:___________

 

Quarterly payments will be made on the last day of February, May, August and November.

(If Deferred Payment Gift Annuity, date of first payment: ___________.)

 

Annual payments will be made on the last day of August.

____Please furnish me with information about direct deposit of my annuity payments.

 

This Annuity is to be nonassignable, except to the Payor.

I herewith transfer to The Vermont Community Foundation the following property:

Cash Amount/Securities: ________________________________________________

Date of Acquisition:________________________________________________

Cost Basis:_______________________________________________________

 

This gift shall be used by the Foundation for its general charitable purposes. (If for a particular purpose, please discuss this first with a Foundation representative and then describe such purpose below.) My signature below indicates that I have read the disclosure statement following this application form.

Signed this ____day of ________, 200__.

________________________________________

Donor Print Name

_________________________________________

Donor Signature

_________________________________________

 

Gift Annuity Disclosure Statement

The right of an annuitant to receive payments under a gift annuity agreement represents a general obligation of The Vermont Community Foundation and does not depend on investment results obtained by The Vermont Community Foundation in any of its funds. The VCF's annual report provides useful information regarding the Foundation's operations and financial condition. Charitable gift annuities are exempt from registration requirements of federal and state securities law as a result of the Philanthropy Protection Act of 1995. A charitable gift annuity is not insurance under the laws of the State of Vermont and is not subject to regulation as insurance by the Department of Banking, Insurance, Securities and Health Care Administration, or protected by an insurance guaranty association.

 

For more information contact:

Thomas W. Smith, CFP®
Senior Philanthropic Advisor
tsmith@vermontcf.org
802-388-3355 ext. 239

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