Charitable Gift Annuity Information Request

Please fill out this form completely for more information about a Charitable Gift Annuity. You are under no obligation to participate in the program.

If you selected SINGLE LIFE:
Name
MM slash DD slash YYYY
If you selected TWO LIVES:
Full Name #1
MM slash DD slash YYYY
Full Name #2
MM slash DD slash YYYY
*Your full birth date is required to determine the fixed-rate and tax-free portion of your annuity contribution.
Must be $10,000 minimum.
Must be $10,000 minimum.
Please forward the HIAS Gift Annuity benefits illustration to:
Name
Address

This information will be treated with complete confidentiality and you are under no obligation to participate in the program. If you have any questions, please contact our Planned Giving Department at 212-613-1366 or e-mail plannedgiving@hias.org.

You may also download this form, here. Please mail completed form to HIAS, Attn: Planned Giving, 411 Fifth Avenue, Suite 1006, New York, NY 10016.