Survivorship Death Benefit Case Design

To request a case design, please fill out this form. We will reach back out to you within two business days.

Agent/Advisor First Name *

Agent/Advisor Last Name *

Agent/Advisor Phone *

Agent/Advisor Email *

Agent/Advisor State *

Have you talked to the client about premium financing yet? *

$ Lowpoint Death Benefit *

Type of Survivorship Policy Design Requested *

What is the maximum the client can afford to pay per year (whether interest payments or a level contribution)? *

Citizenship of Insureds *

What state is the Policy Owner domiciled in? *

Insured 1's First Name *

Insured 1's Last Name *

Insured 1's Biological Gender *

Insured 1's Date of Birth *

Insured 1 Smoker/Non-smoker *

Insured 1's Projected Health Rating *

Insured 2's First Name

Insured 2's Last Name

Insured 2's Biological Gender

Insured 2's Date of Birth

Insured 2 Smoker/Non-Smoker

Insured 2's Projected Health Rating

Household Annual Income *

Household Net Worth *

Liquid Available For Collateral (cannot be IRA or 401k) *

Current 401k or IRA or Pension Values *

Type of collateral client will post *

Willing to move liquid collateral to the lender in order to get a lower borrowing rate? *

Gross Real Estate Value *

Mortgage Debt on Real Estate *

1035 Amount To Be Transferred to New Policy (if any) *

Any current life insurance policies in force? *

If yes, what carrier(s) and what death benefit amount(s)?

List any carriers you do NOT want us to use

We will select the best carrier for this particular case NOT including the one(s) you list here.

Additional Notes

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