New Accounts - MYGA Submission

MYGA Submission

Multi-Year Guarantee Annuity Submission
Did the writing advisor complete all product specific training & obtain all licensing required for this new submission? If no, please complete all requirements before submitting.*

Yes (Proceed with submission)No (Please complete all required training / licensing)
Priority:
If urgent is chosen, select a reasonable due date, and be sure correct delivery method is selected. Communicate directly with New Business team with further clarification.
Documents Requested By:

MonthDayYear
Date
Delivery Method:*
New Accounts Team - Client Communication

Prep App ONLY - No client communication at this time
Rep Information:
Primary Representative:*
Servicing / Submitting Representative:*
Will there be a Split Rep or Rep Change?

Yes
Split Rep or Rep Change Information:
Contract Owner:
Owner Name:*

First NameMiddle NameLast Name
Owner Employment Status:
Owner Age:*
NOT Date of Birth
Joint Owner Name:

First NameMiddle NameLast Name
Annuitant Name (If different than owner name):

First NameMiddle NameLast Name
Beneficiary Info - Full Names - Relationship - Primary or Contingent - % of Distribution
DO NOT include DOB, Social Security Numbers here. But do make sure that information is in redtail
Annuity Details:
Funding Source:*
Account Type:*
Money Type*
What is the current trail?*
Will this create increased or decreased revenue for the term of the investment?*
What is the annual percent of increase or decrease?*
Registration:
i.e. Trust, Roth IRA, IRA, Simple IRA
Company Name:*
Ex. MassMutual Ascend Secure Gain
Product Name:*
Ex. MassMutual Ascend Secure Gain
Intended Rate:
Ex. 4.30%
Term (In Years):
Ex. 5 Year
Investment Amount:*
Commission Option (Owner Age 0-80):
Commission Option (Owner Age 81-85):
Notes & Funding Instructions:*
Please be specific regarding the funding of this account.
How is this account being funded? Select all that apply:

CashBrokerage AccountAnnuity401k/403b/etc
Do you know the name of their plan?

YesNo
Plan name of 401k/403b/etc:
Social Security (monthly) $:
Pension (monthly) $:
Spouse - Social Security (monthly) $:
Spouse - Pension (monthly) $:
Notes - Enter any applicable information related to this case. (Ex. Annuity carrier or product detail consideration)
Suitability:

SUITABILITY QUESTIONS:
Reasons for recommending this annuity:
Main reason for recommendation:*
Main reason other:
2nd reason for recommendation:
2nd reason other:
3rd reason for recommendation:
3rd reason other:
What other specific types of accounts and specific products were discussed as an alternative to this product? *
Please provide your client-specific rationale for recommending this transaction:*
How long does the client intend to own the proposed product?
Does the client plan to take income from the proposed annuity?*

YesNo
At what age does the client plan on taking income?

SUITABILITY SUPPLEMENT:
Please choose all applicable:

Client's total VA/RILA/FIA holdings exceed 60% of their total investable assets [Complete Section A]Client is age 70 or greater [Complete Sections A and B]Client is age 45 or younger [Complete Section C]Client will incur a loss (surrender charges, benefit value losses, etc.) [Complete Section D]

SECTION A - VA/RILA/FIA HOLDINGS EXCEED 60% OF TOTAL INVESTABLE ASSETS OR CLIENT IS AGE 70 OR GREATER

	1a. Current Income	Source
Amount:
Amount:
Amount:
Amount:
Amount:

	1b. Future Income (not this annuity)	Source
Amount:
Amount:
Amount:
Amount:
Amount:

Indicate client's TOTAL annual expenses:
Current Expenses:
If expenses reduced or increased during retirement, (i.e., reduced mortgage, or other) please list reduced amount:
After purchasing this annuity, will the client have sufficient income and liquid assets to meet monthly expenses, financial emergencies, and/or personal purchases without accessing significant cash values from the annuity?
Yes
No

SECTION C - CLIENT AGE 45 OR YOUNGER
If the client's employment situation changed, would he or she anticipate a need to access cash values from this annuity beyond the product and IRS restrictions?

YesNo
Does the client have the ability to contribute to an employee sponsored retirement plan?
Yes
No


If yes, is the client contributing or planning on contributing into the plan?
Yes
No
Does the client intend to make continuing contributions into this proposed annuity?
Yes
No
If choosing an income rider: please explain why guaranteeing income is important now. (The likelihood of receiving additional benefit may be decreased with longer holding periods, and potential growth may be impacted by the cost of the rider.)

SECTION D - CLIENT WILL INCUR A RECOGNIZED LOSS (CHECK ALL THAT APPLY)
SURRRENDER CHARGES
Surrender Charge: $
(Do not Include MVA)
Please explain why you feel it is more beneficial to replace now vs. waiting for the surrender schedule to expire:
Please explain why you feel it is more beneficial to replace the full amount now vs. surrender free amounts until the surrender schedule expires:
Considering the penalty incurred by liquidating the current product before anticipated, how will this be avoided with the proposed annuity?
LOSS OF LIVING BENEFIT GUARANTEES:
Living Current Base Loss Amount: $
(Current Base - New Base)
What has changed since the existing contract inception date that the current product no longer meets the client's needs and goals as originally intended?
If electing a new living benefit rider: why is the client willing to pay for a new guarantee instead of utilizing the current one?
LOSS OF DEATH BENEFIT GUARANTEES:
Death Benefit Loss Amount: $
(Current Base - New Base)
Was the death benefit part of the recommendation for choosing the existing product?

YesNo
Has the client purchased any new life insurance since the original product was purchased?

YesNo
What are the main reasons the client is willing to forfeit a higher guaranteed death benefit value?

Should be Empty:

MYGA Submission

Rep Information:

Contract Owner:

Annuity Details:

Suitability:

Reasons for recommending this annuity: