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Private Annuity Agreement

(An annuity agreement issued by anyone other than an insurance company.)

ANNUITY AGREEMENT

THIS IS A PRIVATE ANNUITY AGREEMENT. THE BENEFITS HEREIN ARE NOT GUARANTEED BY ANY INSURANCE COMPANY OR GOVERNMENTAL AGENCY [NAME] RECIPIENT, referred to as GRANTOR, and [NAME] GRANTOR, referred to as ANNUITANT, agree:

For an adequate and valuable consideration paid to GRANTOR by ANNUITANT, receipt and sufficiency of which is acknowledged by GRANTOR, GRANTOR shall:

Pay the sum of $------ (dollars) per month to ANNUITANT for so long as the ANNUITANT shall live.

At any time, GRANTOR may fully and completely discharge GRANTOR's total responsibility by the purchase of an annuity from an insurance company licensed to issue such annuities in the State of ___________. Upon purchase and delivery of the annuity contract, the GRANTOR's liability shall be novated by the annuity contract and GRANTOR shall have no further liability.

Any benefts herein may be disposed of, assigned, transferred or sold by the ANNUITANT. No disposition, assignment or transfer shall be recognized. The benefits herein shall be paid to ANNUITANT. The benefits described herein shall not be subject to claims of the creditor of the ANNUITANT, including any trustee under Chapter 11 of the United States Code.

This agreement shall be binding upon the assigns, heirs and personal representative of GRANTOR. Should GRANTOR predecease ANNUITANT, GRANTOR's estate shall discharge the remaining obligations hereunder by the purchase of an annuity from an insurance company licensed to issue such annuities in the State of ________.

The parties herein desire that the measure for the breach of this agreement shall be as follows:

the purchase price of an annuity from an insurance company licensed to issue such annuities in the State of GEORGIA, said company having a rating by A.M. Best Co. of "A" or higher.

This is the entire agreement between the parties, and may only be modified in writing executed by the parties hereto.

Dated: _________________.

______________________________

GRANTOR

______________________________

ANNUITANT