Individual Case Design - Lionsmark Capital

Agent/Advisor First Name *

Agent/Advisor Last Name *

Agent/Advisor Phone *

Agent/Advisor Email *

Client First Name *

Client Last Name *

Client Biological Gender *

Client citizenship status *

What state is the Client domiciled in? *

Client Date of Birth *

Projected Health Rating *

Smoker/Non-smoker *

Client Marital Status *

Client Annual Income *

$

Client $ Total Net Worth *

$

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

$

Age you want Income Drawdowns from policy to start *

Death Benefit Amount Requested *

$

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

$

Amount client wants to contribute annually *

Current 401k or IRA or Pension Values *

$

Gross Real Estate Value *

$

Mortgage Debt on Real Estate *

$

Type of collateral client will post *

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

Purpose of Policy *

Any current life insurance policies in force? *