INFORMATION FORM

CA_Y PWF11186 (3/13)

TIAA-CREF Individual & Institutional Services, LLC and Teachers Personal Investors Services, Inc., members FINRA, distribute securities products. Insurance and annuity products issued by TIAA (Teachers Insurance and Annuity Association of America), New York, NY and TIAA-CREF Life Insurance Company, New York, NY. Advice and Planning Services is a division of TIAA-CREF Individual & Institutional Services, LLC.

©2013 Teachers Insurance and Annuity Association of America–College Retirement Equities Fund (TIAA-CREF), 730 Third Avenue, New York, NY 10017

CONGRATULATIONS!

By signing up for an individual counseling meeting with a TIAA-CREF Consultant , you’ve taken an important step toward creating a retirement planning strategy that will help you align your resources with your goals.

To make sure the recommendations we give you truly reflect your situation, we ask that you provide as much of the information below as possible or applicable. If you have completed a Suitability Questionnaire with TIAA-CREF in the past year and if your information has not changed, you need not complete the Financial Profile section. Other sections are optional as noted.

INSTRUCTIONS

COMPLETING AND RETURNING THE FORMPlease return this form to us before your counseling session so that we may process the information in advance. The form can be faxed to 800 914-8922 or mailed to P.O. Box 1259, Charlotte, NC 28201-1259.

SENDING YOUR FINANCIAL STATEMENTS

At this time we will also gather critical financial information from you that is necessary in order to perform a review of your portfolio. Rather than complete the sections of the form where we request this information, you can provide us with copies of your recent investment account statements (including brokerage, retirement plan, 529 or other statements).

If you have questions about your upcoming advice session, please call TIAA-CREF at 800 927-3059. We will be glad to answer them.

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Print in uppercase using black or dark blue ink.

NEED HELP? 800 842-2252

Monday to Friday 8 a.m. – 10 p.m. (ET)

Saturday 9 a.m. – 6 p.m. (ET)

Or visit tiaa-cref.org.

Securities industry regulations require that we collect the following information. Please provide all information requested.

1. CUSTOMER INFORMATION

Title (Mr, Mrs, Ms, Dr, other) First Name

Middle Name

Last Name Suffix (Jr, Sr, other)

Social Security Number Contract Number

Date of Birth (mm/dd/yyyy)

/ /

Evening Telephone Number Daytime Telephone Number

Extension Email Address Gender

M

F

Residence Address (no P.O. Boxes)

City State Zip Code

Mailing Address (if different)

City State Zip Code

Provide only the changes you would like made to your existing systematic payments here.

2. FINANCIAL PROFILE

ASSOCIATED PERSONS

Are you employed by or affiliated with a stock exchange, FINRA, a member firm of an exchange, a municipal securities dealer or TIAA-CREF?

Yes

No

If yes, name of firm:

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2. FINANCIAL PROFILE (CONTINUED)

Are you a/an:

Individual

Partnership

Corporation

Other legal entity

If other than an individual, the names authorized to transact business on behalf of the legal entity:

1.

2.

3.

DISCRETIONARY AUTHORITY

Have you given another person the authority to direct your investments?

No, I have not given another person the authority to direct my investments.

Yes, I have given another person the authority to direct my investments.

Title (Mr, Mrs, Ms, Dr, other) First Name

Middle Name

Last Name Suffix (Jr, Sr, other)

Residence Address (no P.O. Boxes)

City State Zip Code

MARITAL STATUS/DEPENDENTS

Are you married? Spouse’s/Partner’s Name Number of Dependents

Yes

No

EMPLOYMENT STATUS

What is your employment status?

Employed

Unemployed

Retired

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2. FINANCIAL PROFILE (CONTINUED)

Occupation (if employed)

Employer’s Name

Employer’s Street Address (no P.O. Boxes)

City State Zip Code

SAVINGS OBJECTIVES

What are your savings objectives?

College fund Supplemental retirement income Home purchase

Tax-deferred growth Primary retirement income Other

ANNUAL SALARY

What is your annual salary?

$

ANNUAL INCOME

What is your annual income?

Up to $24,999

$75,000 to $99,999

$200,000 to $249,999

$25,000 to $49,999

$100,000 to $149,999

$250,000 or greater

$50,000 to $74,999

$150,000 to $199,999

ADJUSTED GROSS INCOME

What is your adjusted gross income (AGI)?

Up to $24,999

$100,000 to $149,999

$200,000 to $249,999

$25,000 to $49,999

$150,000 to $199,999

$250,000 or greater

$50,000 to $74,999

$75,000 to $99,999

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2. FINANCIAL PROFILE (CONTINUED)

TAX BRACKET

What is your federal tax bracket?

Less than 11%

11%-25%

26%-35%

Over 35%

What are your state and local tax brackets?

State Tax Bracket

Local Tax Bracket

How do you file your Income taxes?

Single

Joint

Head of Household

Married filing separately

NET WORTH (Excluding value of primary residence)

Which category best describes all your assets minus all your liabilities?

Up to $49,999

$200,000 to $499,999

$2,500,000 to $5,000,000

$50,000 to $99,999

$500,000 to $999,999

$5,000,000 or greater

$100,000 to $199,999

$1,000,000 to $2,499,999

CASH & EQUIVALENT (Assets Easily Converted to Cash)

Which amount best describes your cash assets?

Up to $49,999

$200,000 to $499,999

$2,500,000 or greater

$50,000 to $99,999

$500,000 to $999,999

$100,000 to $199,999

$1,000,000 to $2,499,999

SOURCE OF FUNDS (check all that apply)

What is the source of the funds you are investing?

Personal Savings

IRA/Rollover

Life Insurance

Plan Loan

Pension Plan

Gift/Inheritance

Home Mortgage

Plan Hardship Withdrawal

Other:

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2. FINANCIAL PROFILE (CONTINUED)

EMERGENCY FUND

Do you have sufficient liquid assets to meet current and anticipated financial needs?

Yes

No

Unsure

If “No” or “Unsure,” please explain:

INVESTMENT OBJECTIVE What is your investment objective?

Income and capital preservation

Long-term growth

Growth and income

Aggressive growth and speculation

When do you expect to withdraw this money?

Less than 3 years

3 to 5 years

5 to 10 years

10 or more years

INVESTMENT EXPERIENCE What best describes your investment experience?

Beginning or novice investor (no investment experience)

Moderately experienced investor (comfortable with IRAs, mutual funds, and bank CDs)

Knowledgeable investor (has bought or sold individual shares of stock or bonds)

Experienced investor (has traded stock options, exercised stock rights or stock warrants)

What assets do you currently have in your investment portfolio? (check all that apply)

Stocks

Bonds

Mutual Funds

Real Estate

Life Insurance

What is the approximate value of this portfolio?

$

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2. FINANCIAL PROFILE (CONTINUED)

RISK TOLERANCE

Which of the following statements more closely describes your personal investment strategy?

One that seeks to avoid loss

One that accepts some risk in exchange for potentially higher returns

One that accepts higher risk in exchange for potentially higher returns

One that seeks to maximize potentially higher returns regardless of the potential for loss

ANNUITY CONTRACTS

Why is this annuity being established?

Systematic withdrawals

Income options

Lower fees and charges

Investment options

Death benefit

Will this annuity contract replace an existing annuity contract or life insurance policy from another company?

Yes

No

N/A

Have you replaced or exchanged an annuity contract within the last 36 months?

Yes

No

SECONDARY CUSTOMER INFORMATION FOR JOINT ACCOUNTS, IF APPLICABLE

Include Spouse/Partner in Overall Retirement Plan?

Yes

No

If yes, please complete the following:

Title (Mr, Mrs, Ms, Dr, other) First Name

Middle Name

Last Name Suffix (Jr, Sr, other)

Evening Telephone Number Daytime Telephone Number Extension

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2. FINANCIAL PROFILE (CONTINUED)

Email Address

Date of Birth (mm/dd/yyyy) Gender Marital Status Number of Dependents

/ /

M

F

M

S

Residence Address (no P.O. Boxes)

City State Zip Code

Mailing Address (if different)

City State Zip Code

Are you employed by or affiliated with a stock exchange, FINRA, a member firm of an exchange, a municipal securities dealer or TIAA-CREF?

Yes

No

If yes, name of firm:

Employment Status:

Employed

Unemployed

Retired

Occupation (if employed)

Employer’s Name

Employer’s Street Address (no P.O. Boxes)

City State Zip Code

What is your adjusted gross income (AGI)?

Up to $24,999

$100,000 to $149,999

$200,000 to $249,999

$25,000 to $49,999

$150,000 to $199,999

$250,000 or greater

$50,000 to $74,999

$75,000 to $99,999

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2. FINANCIAL PROFILE (CONTINUED)ANNUAL SALARY

What is your annual salary?

$

CURRENT FINANCIAL ADVISOR

Check here if you DO NOT have a financial advisor

Last Name

First Name

Current Address

City State Zip Code

What level of discretion have you assigned to this advisor?

Full

Limited

Does the advisor have discretion over all or only some of your assets?

Some

All

3. RETIREMENT PLANNING INFORMATION

Expected Retirement Age:

Expected Spouse/Partner Retirement Age: (enter 65 if you don’t know)

At what age do you expect to begin receiving income?

Desired After-Tax Annual Retirement Income: $ or

Percentage of current salary %

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3. RETIREMENT PLANNING INFORMATION (CONTINUED)

If you have earmarked any of your retirement savings for nonretirement purposes, such as paying tuition bills, please note them below.

Name of Source Annual Amount Needed

$

Duration (mm/dd/yyyy)

/ /

TO / /

Include Annual Social Security Income?

Yes

No

Default to Advice Tool Estimate

OR

Enter Annual Estimate: $

Beginning At (Age/Year):

Other Pension Income Not Noted Above (for example, a defined benefit plan):

Name of Source Annual Amount Needed

$

Duration (mm/dd/yyyy)

/ /

TO / /

Other Existing Annuities:

Name of Source Annual Income

$

Cost of Living Increases: Yes

No

Other Sources of Retirement Income (for example, rental income):

Name of Source Annual Income

$

Duration (mm/dd/yyyy)

/ /

TO / /

Do you see yourself working part time after retiring? Yes

No

If yes, how long?

Expected Income? $

Do you expect to stay in the area after retirement? Yes

No

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For retirement assets you may have with companies other than TIAA-CREF, we will need you to supply the information at right.

Please duplicate Section 4 if you have additional investment accounts or plans.

We cannot provide specific investment recommendations or allocation strategies on these assets, as we can on TIAA-CREF accounts. However, our service does need to consider all your retirement savings in order to evaluate whether you have enough potential retirement income to reach your goals and whether your overall investment mix is consistent with your desired strategy.

4. ASSETS OUTSIDE OF TIAA-CREF

If you prefer, you can provide us with copies of your recent investment account statements instead of completing the information in Section 4.

Pretax Accounts

Account Type Value Name of Financial Institution Ownership Self Spouse/ Partner 401(k), 401(a), 403(b) $

457(b), 457(f), 414(h) $

IRAs (Traditional, Roth, SEP) $

Keoghs $

$

After-Tax Accounts

Account Type Value Name of Financial Institution Ownership Self Spouse/ Partner

After-Tax Investments $

Brokerage $

CDs $

Stock Options $

Variable Annuity $

$

OR

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4. ASSETS OUTSIDE OF TIAA-CREF (CONTINUED)

Name of Financial Institution Account Type(i.e. Fidelity, American, Wells Fargo, etc.) (i.e. 403(b), 457(b), IRA, etc.)

% Large-Cap Equities % Bonds/Fixed Income

% Mid-Cap Equities % Cash/Money Market

% Small-Cap Equities % Guaranteed

% International Equities % Balanced

Value

Name of Financial Institution Account Type(i.e. Fidelity, American, Wells Fargo, etc.) (i.e. 403(b), 457(b), IRA, etc.)

% Large-Cap Equities % Bonds/Fixed Income

% Mid-Cap Equities % Cash/Money Market

% Small-Cap Equities % Guaranteed

% International Equities % Balanced

Value

Name of Financial Institution Account Type(i.e. Fidelity, American, Wells Fargo, etc.) (i.e. 403(b), 457(b), IRA, etc.)

% Large-Cap Equities % Bonds/Fixed Income

% Mid-Cap Equities % Cash/Money Market

% Small-Cap Equities % Guaranteed

% International Equities % Balanced

Value

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4. ASSETS OUTSIDE OF TIAA-CREF (CONTINUED)

I would like to provide more detail below

Security [S] Investment Name(s)/Symbol(s) Current Balance OR Current OR Fund [F] OR Asset Class from list above Share Price and # Shares

$

$

$

$

$

5. INCOME PROTECTION AND ESTATE PLANNING

Do you have an existing life insurance policy?

Yes

No

Based on your current life insurance coverage, about how many times your current annual income is your life insurance coverage? For example, for a $125,000 salary, $750,000 life insurance (750/125) is 6 times current income in life insurance coverage.

5 times

10 times

15 times

20 times

25 times Other:

Please rate the following planning priorities: One being the highest priority and five being the lowest priority

How to protect my family’s lifestyle: 1

2

3

4

5

Insurance on myself: 1

2

3

4

5

How to pay estate taxes/wealth preservation: 1

2

3

4

5

Insurance on my spouse/partner: 1

2

3

4

5

Funding my charitable gifting: 1

2

3

4

5

Financial needs/gap analysis:

1 2

3

4

5

Securing a legacy for my children: 1

2

3

4

5

Obtaining lifelong insurance coverage: 1

2

3

4

5

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6. MEDICAL EXPENSES

Does your employer provide retiree healthcare benefits? Yes

No

Will you be responsible for any cost related to this healthcare benefit? Yes

No

At the present time, do you anticipate having higher than average healthcare costs in the future?

Yes

No

7. INTERESTED IN TIAA-CREF PRODUCTS?

Please identify any TIAA-CREF products you would like to discuss:

Mutual Funds

Tax-Deferred Annuities

Brokerage Accounts

IRA Rollovers

Trust Company Services

529 Plans or Education Savings Accounts

Roth IRA

Private Asset Management

Life Insurance

8. SIGNATURES

Client’s Signature

Client’s Name Today’s Date (mm/dd/yyyy)

/ / 20

Co-Client’s Signature

Co-Client’s Name Today’s Date (mm/dd/yyyy)

/ / 20