Annuity Quote IIB

Annuity Quote Request
Agent/Advisor Information
Agent/Advisor Name

First NameLast Name
E-Mail
Phone Number
Agent/Advisor State
Annuitant Information
Joint Annuitants
Name

First NameLast Name
Gender
Date of Birth

MonthDayYear
Date
Additional Annuitant
Name

First NameLast Name
Gender
Date of Birth

MonthDayYear
Date
Financial Profile
Annual Gross income (combine for joint annuitants)
Source of Income (check all that apply)

Other
Estimated Net Worth (exclude tangible assets)
Current Savings and Investments (liquid net worth) *
What type of investments and insurance products do they own?
What is the purpose of this annuity?

Other
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? *
How long has the policy or contract been in force?
What is the surrender charge?
Plan Design
Issuing State
Premium Amount
Can have multiple entries
Years of Deferral
1 - 10
Death Benefit
Confinement / LTC
Types of Funds
Premium Type
At least A Rated
Case Specific Information
Preferred Carriers
Present With Business Builder?
Business Builder is a new software where it puts annuity ledgers side by side, up to 3 at a time.
Any Additional Information?
For Questions Please call 317-663-0061
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Annuity Quote Request