Report a variable annuity and income from the annuity in Part 6.

For You, Your Spouse, and Your Dependent Children

Part 6

Reporting the Overall Variable Annuity

Report a variable annuity if the total value of the annuity was more than $1,000 at the end of the reporting period or if more than $200 in income was received during the reporting period.  Income is ordinarily reported when the annuity begins making payments.

Description:  Provide the name of the insurance company issuing the annuity and write “variable annuity.”

EIF:  Select “No” because a variable annuity is an investment vehicle that does not qualify as an excepted investment fund.

Income Type:  If applicable, describe the type of income received as “cash payments” or “cash distributions.”

Income Amount:  Provide the exact amount of income received during the reporting period.  If you do not have such income to report, leave this field blank.

Reporting the Underlying Assets

If the overall annuity is reportable, provide the names of each underlying asset within the annuity that individually was worth more than $1,000 at the end of the reporting period.

Description:  Provide the name of the underlying asset.

EIF:  For each underlying asset, indicate whether the asset (1) is an investment vehicle that qualifies as an EIF (“Yes”), (2) is an investment vehicle that does not qualify as an EIF (“No”), or (3) is not an investment vehicle that holds other assets (“N/A”).

Value:  Report the value of the underlying asset by selecting the appropriate category.

Income Amount:  Select the category for “None (or less than $201).”