Survivorship Death Benefit Case Design

Agent/Advisor First Name *

Agent/Advisor Last Name *

Agent/Advisor Phone *

Agent/Advisor Email *

$ 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) *

$