First Trinity Financial CORP - FORM S-1/A - EX-99.10 - May 17, 2010

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S-1/A - FORM S-1/A - First Trinity Financial CORPd73107sv1za.htm
EX-23.2 - EX-23.2 - First Trinity Financial CORPd73107exv23w2.htm
EXHIBIT 99.10
SUBSCRIPTION AGREEMENT
FIRST TRINITY FINANCIAL CORPORATION
The undersigned acknowledges receipt of a copy of the Prospectus (the “Prospectus”) dated                     , 2010 relating to the offering of shares of common stock of First Trinity Financial Corporation, an Oklahoma corporation (the “Corporation”). The shares are being offered by the Corporation at $7.50 per share and in the manner described in the Prospectus.
1.   Subscription. Subject to the terms and conditions of this Agreement and the Prospectus, the undersigned hereby irrevocably subscribes for and agrees to purchase                      shares and tenders here with a check in the amount of $                     payable to First Trinity Financial Corporation. This amount represents a total payment of the subscription price payable to the Corporation.
2.   Acceptance of Subscription. The undersigned understands and agrees that this subscription is subject to the following terms and conditions:
  (a)   The Corporation has the right to reject this subscription in whole or in part.
 
  (b)   The foregoing subscription is made subject to all of the terms set out in the Prospectus.
 
  (c)   The subscription will be held in escrow until the minimum number of shares are sold by the Company as described in the Prospectus.
3.   Place of Residence. The undersigned hereby certifies that as of the date hereof, he is a bona fide resident of the State of Oklahoma and agrees to notify the Corporation promptly of any change of address
4.   Suitability. The undersigned hereby certifies that they have a minimum annual gross income of $75,000 and a minimum net            worth of $75,000 excluding vehicles, home and home furnishings or a minimum net worth of $150,000 excluding vehicles, home, and home furnishings. In addition, the undersigned certifies that they are not investing more than 10% of their net worth, excluding vehicles, home and home furnishings.

         
 
 Signature of Subscriber
 
        
     
 Name Printed or Typed   D.O.B.
 
        
 
 Subscriber’s Social Security or Taxpayer I.D. No.
 
        
 
Subscriber’s Oklahoma Driver’s License No.
 
        
 
 Street Address
 
        
 
City
        
 
  State                Zip    
 
County
        
 
        
 
Home Phone No.
  Work Phone No.    
 
        
 
 Title and Occupation
        
 
        
 Email Address
 
     
Name(s) in which certificate to be issued:
 
    
o SUBSCRIBER’S
  o ADDRESS SAME AS
      SUBSCRIBER’S
         
     
 Name
      D.O.B.
 
        
     
 Name
      D.O.B.
 
        
 
  Street Address
 
        
 
City
        
 
  State                Zip    
 
County
        
 
        
 
Certificate Holder’s Social Security or Taxpayer I.D. No.
 
        
Issue Certificate as Follows:
 
        
o Individual                o Joint Tenants with Right of Survivorship
 
        
o Tenants In Common
  o Uniform Gift to Minors    
 
        
o Other:
        
 
        
 


FIRST TRINITY FINANCIAL CORPORATION Subscription Dated                                          at (City)                                                                                 , Oklahoma
                     
By:
          By:        
 
                   
 
  Authorized Representative   Rep. No.       Authorized Representative   Rep. No.
Make all checks payable to FIRST TRINITY FINANCIAL CORPORATION
     
 
   
Signature of Subscriber
  Signature of Subscriber
         
WHITE COPY—Office   YELLOW COPY—Subscriber   PINK COPY—Agent

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