Annuity Quote Request
Annuitant #1 Information
Annuitant #2 Information
Financial Profile & Plan Design
(Combine for Joint Annuitants)
Source of Income (Check All the Apply)
If Other was Selected, Please explain below
(Exclude Tangible Assets)
(Liquid Net Worth)
What type of investments and insurance products do they own?
If Other was Selected, Please Explain Below
How long do they plan to keep their money in the annuity before drawing an income?
Are they considering discontinuing making premium payments, surrendering, forfeiting, assigning to the insurer, or otherwise terminating an existing life insurance policy or annuity contract OR using monies from existing life insurance policies or annuity contracts to contribute to the new contract?
If Yes, how long has the policy or contract been in force?
If Yes, what is the surrender charge?
Confinement / LTC?
At Least A Rated?