Case Design Request Form
Agent's Full Name
*
ex. John Smith
Agent's Email
*
example@example.com
Your Company
*
Put In Your Client's Information Below:
Name Of Owner Of Qualified Funds:
*
Premium Amount
*
(Numbers Only - Enter The Full Number, Ex. 500000 instead of 500k)
What Cash Bonus %?
*
Please Select
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
*CHECK THE STATE YOUR CLIENT IS IN AND THEIR AGE FOR BONUS VARIATIONS* We will try and catch errors, but please do your due diligence.
Assumed Rate of Return
*
Please Select
0%
1%
2%
3%
4%
5%
6%
7%
Show RMD's being taken?
*
Please Select
Yes
No
Use net RMD's to offset taxes owed from policy?
*
Please Select
Yes
No
If client doesn't need RMDs for income, this will use the RMD distribution, net of taxes, to help pay for the taxes owed on the conversion amount, allowing more money to be converted into Roth funds.
Calculate Taxes?
*
Please Select
Yes
No
Taxes will be calculated, but not subtracted to show client the estimated taxes owed.
Subtract Taxes?
*
Please Select
Yes
No
THE "CALCULATE TAXES?" DROPDOWN HAS TO BE YES IF THIS IS ALSO SELECTED AS YES.
Age Of Owner
*
(Numbers Only)
Birth Date Of Owner
-
Month
-
Day
Year
(OPTIONAL)
Choose Which Carrier:
*
Please Select
Athene
American Equity
Equitrust
North American
Allianz
American Life
Estimated Effective Income Tax Percentage:
*
Please Select
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
Be sure to account for state taxes if the client's state has them. Be realistic with your tax assumptions. Example: A $1,000,000 premium being converted isn't going to be a 12% tax rate.
Marital Status:
*
Please Select
Single
Married
Divorced
Widowed
Age Of Spouse:
(OPTIONAL)
Estimated Age Of Death Of Owner:
(OPTIONAL)
Estimated Age of Death For Spouse:
(OPTIONAL)
State Residence:
*
Please Select
AL
AK
AZ
AR
CA
CO
CT
DE
FL
GA
HI
ID
IL
IN
IA
KS
KY
LA
ME
MD
MA
MI
MN
MS
MO
MT
NE
NV
NH
NJ
NM
NY
NC
ND
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VT
VA
WA
WV
WI
WY
When Is Your Next Meeting With This Client?
*
-
Month
-
Day
Year
Date
NOTES (Type any additional notes; if none type 'N/A')
*
Submit
Should be Empty: