ANNUITY MAX

ANNUITY MAX

Client Information Intake Form
Section 1 - Advisor Information
Advisor Name*
Phone Number*
Email*
Section 2- Client Information
Name*
Age*
DOB*
Gender*

MaleFemale
Tobacco/Nicotine Substitutes*

NoYes
Rate Class*

StandardFemale
Spouse Name
Age*
DOB*
Gender*

MaleFemale
Tobacco/Nicotine Substitutes*

NoYes
Rate Class*

StandardFemale
Section 3 - Existing Annuity Information
Annuity Type*

QualifiedNon-qualified
State Estate Tax Rate*
Annuity Balance:*
Annuity Cost Basis:*
Assumed Tax Bracket of Insured(s):*

10%12%22%24%32%35%37%Other _______ %
Assumed Tax Bracket of Heir(s):*

10%12%22%24%32%35%37%Other _______%
Net Hypothetical Growth Rate of Annuity*

3%4%5%6%7%Other _______ %
Completion Tips:
For better comparative results, select 1) Higher rate class 2) Higher Heir Tax Bracket vs Insured.
Should be Empty:

Section 1 - Advisor Information