• New Accounts & Transfers to Existing Accounts

    Revised 10/30/2025
  • Priority*
  • Documents requested by:
     - -
  • Delivery Method (Be sure your selection matches client expectations)*
  • Client Communication - our team will contact the client as needed to fulfill submissions unless NO is selected - CAN THE TEAM CONTACT THE CLIENT?*
  • Will there be a Split Rep or Rep Change?

  • Client Detail for all clients related to submissions made today

  • Clients (Age)*
  • Clients (Employment Status)*
  • Spouse (Age)
  • Spouse (Employment Status)

  • Client Financials - IMPORTANT please provide this information to update our records and to satisfy supervision

    Per Supervision this DATA must reflect current values to ensure acceptable ratios of investments vs liquidity. Your input at least annually will allow our records to be updated accurately.

  • your input will prevent issue or delays with your submission old data in our records will not satisfy

  • Annual Living Expenses:*
  • Range of Upcoming Special Expenses:
  • Time frame of the Special Expenses:

  • Submission Categories

  • Check all application types that you will be submitting today

  • Annuity - VA (Contract Details)

  • Registration Type:*
  • Have all persons related to this submission been fully onboarded?*
  • Has onboarding been formally requested?
  • If this submission involves funds or accounts that are not managed in house, a statement is required to proceed. Does this submission involve funds or accounts that are NOT managed in house?*
  • Has the statement been collected?
  • Rebalancing Frequency (Default for Annuities is NONE. Will only be added if requested):
  • Dollar Cost Average:
  • Funding Source:*
  • How is this account being funded? (Select all that apply)*
  • Do you know the name of their plan?*
  • Does the client have access to their Form 404(a)(5)
  • Is the client currently employed at this company?
  • How much access does the plan provide?
  • Is the client satisfied with plan investment options?
  • Does the plan offer other insurance products as a benefit?
  • Does the plan offer a self-directed option?
  • Does the plan offer life insurance as a benefit?
  • Would the client like to consider a cashout?
  • VA Allocation:*
  • VA Owner Age Range:*
  • VA Comp Option (Owner Age 0 - 80)*
  • VA Comp Option (Owner Age 81 - 85)*
  • VA Comp Option (Owner Age 86 - 90)*

  • Annuity - VA (Distributions)

  • Distributions - IMPORTANT - to ensure that the client & the team are clear on CURRENT distributions due to change, & NEW distribution details.
    Note - the timing of account opening and funding may disrupt a clients current routine for distributions. Please advise of an interim plan for distribution(s) from another account, if needed, to keep the clients income expectations on track while new account processes are in motion.

  • Does the account need to be setup for distributions?*
  • Will this impact an already established routine distribution in the TO or FROM account?*

  • Annuity - VA (Suitability/Duty of Care)

  • Main Reason for recommendation:*
  • 2nd Reason for recommendation:
  • 3rd Reason for recommendation:
  • What SPECIFIC types of accounts SPECIFIC products were discussed as an alternative to this product? Submissions require the NAMES of products and not just product types.*
  • How long does the client intend to own the proposed product?*
  • Does the client plan to take income from the proposed annuity?*

  • Annuity - VA (Suitability Supplement)

  • Is this annuity replacing an existing annuity?*
  • Does the annuity being replaced have any kind of rider the client has been paying a fee for?*
  • If yes,
  • Reasons for surrender (Select all that apply)*
  • Is an income benefit rider a feature of the new annuity?
  • If choosing an income benefit rider (Please indicate the primary need or intention for the distributions)
  • Do the client's total annuity holdings exceed 60% of their total investable assets?
  • Is client 70 years of age or greater?*
  • Is client 45 years of age or younger?*

  • Section A - Required if annuity holdings exceed 60% of total investable assets or client is age 70 or older

  • Rows

  • Section B - Required if client is 70 or older

  • Is CLIENT aware of all applicable maximum age limitations for the GUARANTEED BENEFIT values involved?
  • LIFETIME WITHDRAWAL RIDER - is the CLIENT aware that principal has to be depleted before the rider provides additional guaranteed value? (WD benefits typically require up to 15-20 yrs to recognize additional returns due to max wd restrictions)
  • Was anyone else involved in this investment decision?

  • Section C - Client 45 or Younger

  • If the client's employment situation changed, will they need to access cash values from this annuity beyond the product and IRS restrictions?
  • Does the client have the option to contribute to an ESP?
  • Is the client current contribution to an ESP?
  • Will the client be making continuing contributions to this annuity?

  • Annuity - RILA (Contract Details)

  • Registration Type:*
  • If this submission involves funds or accounts that are not managed in house, a statement is required to proceed. Does this submission involve funds or accounts that are NOT managed in house?*
  • has the statement been collected?*
  • Rebalancing Frequency (Default for Annuities is NONE. Will only be added if requested):
  • Dollar Cost Average:
  • Funding Source:*
  • How is this account being funded?*
  • Do you know the name of their plan?
  • Does the client have access to their Form 404(a)(5)
  • Is the client currently employed at this company?
  • How much access does the plan provide?
  • Is the client satisfied with plan investment options?
  • Does the plan offer other insurance products as a benefit?
  • Does the plan offer a self-directed option?
  • Does the plan offer life insurance as a benefit?
  • Would the client like to consider a cashout?
  • RILA Allocation:*
  • RILA Owner Age Range:*
  • RILA Comp Option (Owner Age 0 - 80)*
  • RILA Comp Option (Owner Age 81 - 85)*
  • RILA Comp Option (Owner Age 86 - 90)*

  • Annuity - RILA (Distributions)

  • Distributions - IMPORTANT - to ensure that the client & the team are clear on CURRENT distributions due to change, & NEW distribution details.
    Note - the timing of account opening and funding may disrupt a clients current routine for distributions. Please advise of an interim plan for distribution(s) from another account, if needed, to keep the clients income expectations on track while new account processes are in motion.

  • Does the account need to be setup for distributions?*
  • Will this impact an already established routine distribution in the TO or FROM account?*

  • Annuity - RILA (Suitability/Duty of Care)

  • Main Reason for recommendation:*
  • 2nd Reason for recommendation:
  • 3rd Reason for recommendation:
  • What SPECIFIC types of accounts SPECIFIC products were discussed as an alternative to this product? Submissions require the NAMES of products and not just product types.*
  • How long does the client intend to own the proposed product?*
  • Does the client plan to take income from the proposed annuity?*

  • Annuity - RILA (Suitability Supplement)

  • Is this annuity replacing an existing annuity?*
  • Does the annuity being replaced have any kind of rider the client has been paying a fee for?*
  • If yes,
  • Reasons for surrender (Select all that apply)*
  • Is an income benefit rider a feature of the new annuity?
  • If choosing an income benefit rider (Please indicate the primary need or intention for the distructions)
  • Do the client's total annuity holdings exceed 60% of their total investable assets?*
  • Is client 70 years of age or greater?*
  • Is client 45 years of age or younger?*

  • Section A - Required if annuity holdings exceed 60% of total investable assets or client is age 70 or older

  • Rows

  • Section B - Required if client is 70 or older

  • Is CLIENT aware of all applicable maximum age limitations for the GUARANTEED BENEFIT values involved?
  • LIFETIME WITHDRAWAL RIDER - is the CLIENT aware that principal has to be depleted before the rider provides additional guaranteed value? (WD benefits typically require up to 15-20 yrs to recognize additional returns due to max wd restrictions)
  • Was anyone else involved in this investment decision?

  • Section C - Client 45 or Younger

  • If the client's employment situation changed, will they need to access cash values from this annuity beyond the product and IRS restrictions?
  • Does the client have the option to contribute to an ESP?
  • Is the current contribution to an ESP?
  • Will the client be making continuing contributions to this annuity?

  • Annuity - FIA (Contract Details)

  • Registration Type:*
  • If this submission involves funds or accounts that are not managed in house, a statement is required to proceed. Does this submission involve funds or accounts that are NOT managed in house?*
  • Has the statement been collected?
  • Rebalancing Frequency (Default for Annuities is NONE. Will only be added if requested):
  • Dollar Cost Average:
  • Funding Source:*
  • How is this account being funded?*
  • Do you know the name of their plan?
  • Does the client have access to their form 404(a)(5)
  • Is the client currently employed at this company?
  • How much access does the plan provide?
  • Is the client satisfied with plan investment options?
  • Does the plan offer other insurance products as a benefit?
  • Does the plan offer a self-directed option?
  • Does the plan offer life insurance as a benefit?
  • Would the client like to consider a cashout?
  • FIA Allocation:
  • FIA Owner Age Range:*
  • FIA Comp Options (Owner Age 0 - 80):*
  • FIA Comp Option (Owner Age 81 - 85):*

  • Annuity - FIA (Distributions)

  • Distributions - IMPORTANT - to ensure that the client & the team are clear on CURRENT distributions due to change, & NEW distribution details.
    Note - the timing of account opening and funding may disrupt a clients current routine for distributions. Please advise of an interim plan for distribution(s) from another account, if needed, to keep the clients income expectations on track while new account processes are in motion.

  • Does the account need to be setup for distributions?*
  • Will this impact an already established routine distribution in the TO or FROM account?*

  • Annuity - FIA (Suitability/Duty of Care)

  • Main Reason for recommendation:*
  • 2nd Reason for recommendation:
  • 3rd Reason for recommendation:
  • What SPECIFIC types of accounts SPECIFIC products were discussed as an alternative to this product? Submissions require the NAMES of products and not just product types.*
  • How long does the client intend to own the proposed product?*
  • Does the client plan to take income from the proposed annuity?*

  • Annuity - FIA (Suitability Supplement)

  • Is this annuity replacing an existing annuity?*
  • Does the annuity being replaced have any kind of rider the client has been playing a fee for?*
  • If yes,*
  • Reasons for surrender (Select all that apply)*
  • Is an income benefit rider a feature of the NEW annuity?
  • If choosing an income benefit rider (Please indicate the primary need or intention for the distributions)
  • Do the client's total annuity holdings exceed 60% of their total investable assets?
  • Is client 70 years of age or greater?
  • Is client 45 years of age or younger?

  • Section A - Required if annuity holdings exceed 60% of total investable assets or client is age 70 or older

  • Rows

  • Section B - Required if client is 70 or older

  • Is CLIENT aware of all applicable maximum age limitations for the GUARANTEED BENEFIT values involved?
  • LIFETIME WITHDRAWL RIDER - is the CLIENT aware that principal has to be depleted before the rider provides additional guaranteed value? (WD benefits typically require up to 15-20 yes to recognize additional returns due to max wd restrictions)
  • Was anyone else involved in this investment decision?

  • Section C - Client 45 or Younger

  • If the client's employment situation changed, will they need to access cash values from this annuity beyond the product and IRS restrictions?
  • Does the client have the option to contribute to an ESP?
  • Is the client current contribution to an ESP?
  • Will the client be making continuing contributions to this annuity?

  • MYGA 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.*
  • Priority:*
  • Documents Requested By:
     - -
  • Delivery Method

  • MYGA Submission (Annuity Details)

  • Funding Source:*
  • Account Type:*
  • Commission Option (Owner Age 0 - 80)*
  • How is this account being funded? (Select all that apply)*
  • Do you know the name of their plan?

  • MYGA Submission (Suitability)
    Reasons for recommending this annuity:

  • Main Reason for recommendation:*
  • 2nd Reason for recommendation:
  • 3rd Reason for recommendation:
  • How long does the client intend to own the proposed product?*
  • Does the client plan to take income from the proposed annuity?

  • MYGA Submission (Suitability Supplement)

  • Do the client's total annuity holdings exceed 60% of their total investable assets?
  • Is client 70 years of age or greater?*
  • Is client 45 years of age or younger?

  • Section A - Required if annuity holdings exceed 60% of total investable assets or client is age 70 or older

  • Rows

  • Section B - Required if client is 70 or older

  • Is client aware of all applicable maximum age limitations for the guaranteed benefit values involved?
  • Lifetime Withdrawal Rider - is the client aware that principal has to be depleted before the rider provides additional guaranteed value? (WD benefits typically require up to 15 - 20 years to recognize additional returns due to max WD restrictions)
  • Was anyone else involved in this investment decision?

  • Section C - Client 45 or Younger

  • If the client's employment situation changed, will they need to access cash values from this annuity beyond the product and IRS restrictions?
  • Does the client have the option to contribute to an ESP?
  • Is the client current contribution to an ESP?
  • Will the client be making continuing contributions to this annuity?

  • Pershing Account (Submission Details)

  • Have you confirmed the following details in Redtail? (This submission can not proceed without this info)*
  • Have all persons related to this submission been fully onboarded?*
  • Has onboarding been formally requested?
  • If this submission involves funds or accounts that are not managed in house, a statement is required to proceed. Does this submission involve funds or accounts that are NOT managed in house?*
  • Has the statement been collected?

  • Pershing Account (Client Investment Experience)

  • Client Investment Knowledge*
  • Source of Wealth*

  • Investment One

  • Investment One - Investment Objective
  • Investment Purpose
  • Funding Source:
  • How is this account being funded? (Select all that apply)
  • Do you know the name of their plan?
  • Does the client have access to their form 404(a)(5)?
  • Is the client currently employed at this company?
  • How much access does the plan provide?
  • Which best describes the company's size?
  • Is the client satisfied with plan investment options?
  • Does the plan offer insurance products as a benefit?
  • Does the plan offer a self-directed option?
  • Does the plan offer life insurance as a benefit?
  • Would the client like to consider a cashout?
  • Rebalancing Frequency (If nothing is selected, the default for NQ is NO rebalancing/the default for Q is annual. Select Default to choose these, or select Custom to provide other direction)
  • Account Type:
  • Qualified Registration Type:
  • Non-Q Registration Type:
  • Program:
  • UMA Risk Tolerance Questionnaire Results:
  • AMP Risk Tolerance Questionnaire
  • AMP Model (Level 1)
  • AMP Model (Level 2)
  • AMP Model (Level 3)
  • AMP Model (Level 4)
  • AMP Model (Level 5)
  • UMA Model (Level 1)
  • UMA Model (Level 2)
  • UMA Model (Level 3)
  • UMA Model (Level 4)
  • UMA Model (Level 5)
  • Dollar Cost Average
  • AMP Fee Schedule
  • Advisor Fee:*

  • Distributions - IMPORTANT - Please ensure that the client & the team are clear on CURRENT distributions due to change, & NEW distribution details.
    Note - the timing of account opening and funding may disrupt a clients current routine for distributions. Please advise of an interim plan for distribution(s) from another account, if needed, to keep the clients income expectations on track.

  • Does the account need to be setup for routine distributions?*
  • Rows
  • Will this impact an already established routine distribution in the TO or FROM account?*
  • Rows
  • What SPECIFIC types of accounts or SPECIFIC products were discussed as an alternative to this product?*
  • What specifically about this product motivated you and the client to choose it?*
  • Will there be another Pershing Investment?

  • Investment Two

  • Investment Two - Investment Objective
  • Investment Purpose
  • Funding Source:
  • How is this account being funded? (Select all that apply)
  • Do you know the name of their plan?
  • Does the client have access to their form 404(a)(5)?
  • Is the client currently employed at this company?
  • How much access does the plan provide?
  • Which best describes the company's size?
  • Is the client satisfied with plan investment options?
  • Does the plan offer insurance products as a benefit?
  • Does the plan offer a self-directed option?
  • Does the plan offer life insurance as a benefit?
  • Would the client like to consider a cashout?
  • Money Type:
  • Rebalancing Frequency (If nothing is selected, the default for NQ is NO rebalancing/the default for Q is annual. Select Default to choose these, or select Custom to provide other direction)
  • Account Type:
  • Qualified Registration Type:
  • Non-Q Registration Type:
  • Program:
  • UMA Risk Tolerance Questionnaire
  • AMP Risk Tolerance Questionnaire Results:
  • AMP Model (Level 1)
  • AMP Model (Level 2)
  • AMP Model (Level 3)
  • AMP Model (Level 4)
  • AMP Model (Level 5)
  • UMA Model (Level 1)
  • UMA Model (Level 2)
  • UMA Model (Level 3)
  • UMA Model (Level 4)
  • UMA Model (Level 5)
  • Dollar Cost Average
  • Amp Fee Schedule
  • Advisor Fee:*

  • Distributions - IMPORTANT - Please ensure that the client & the team are clear on CURRENT distributions due to change, & NEW distribution details.
    Note - the timing of account opening and funding may disrupt a clients current routine for distributions. Please advise of an interim plan for distribution(s) from another account, if needed, to keep the clients income expectations on track.

  • Does the account need to be setup for routine distributions?*
  • Rows
  • Will this impact an already established routine distribution in the TO or FROM account?*
  • Rows
  • What SPECIFIC types of accounts SPECIFIC products were discussed as an alternative to this product?*
  • What specifically about this product motivated you and the client to choose it?*
  • Will there be another Pershing Investment?

  • Investment Three

  • Investment Three - Investment Objective
  • Investment Purpose
  • Funding Source:
  • How is this account being funded? (Select all that apply)
  • Do you know the name of their plan?
  • Does the client have access to their form 404(a)(5)?
  • Is the client currently employed at this company?
  • How much access does the plan provide?
  • Which best describes the company's size?
  • Is the client satisfied with plan investment options?
  • Does the plan offer insurance products as a benefit?
  • Does the plan offer a self-directed option?
  • Does the plan offer life insurance as a benefit?
  • Would the client like to consider a cashout?
  • Rebalancing Frequency (If nothing is selected, the default for NQ is NO rebalancing/the default for Q is annual. Select Default to choose these, or select Custom to provide other direction)
  • Account Type:
  • Qualified Registration Type:
  • Non-Q Registration Type:
  • Program:
  • UMA Risk Tolerance Questionnaire Results:
  • AMP Risk Tolerance Questionnaire Results:
  • AMP Model (Level 1)
  • AMP Model (Level 2)
  • AMP Model (Level 3)
  • AMP Model (Level 4)
  • AMP Model (Level 5)
  • UMA Model (Level 1)
  • UMA Model (Level 2)
  • UMA Model (Level 3)
  • UMA Model (Level 4)
  • UMA Model (Level 5)
  • Dollar Cost Average
  • AMP Fee Schedule
  • Advisor Fee:*

  • Distributions - IMPORTANT - Please ensure that the client & the team are clear on CURRENT distributions due to change, & NEW distribution details.
    Note - the timing of account opening and funding may disrupt a clients current routine for distributions. Please advise of an interim plan for distribution(s) from another account, if needed, to keep the clients income expectations on track.

  • Does the account need to be setup for routine distributions?*
  • Rows
  • Will this impact an already established routine distribution in the TO or FROM account?*
  • Rows
  • What SPECIFIC types of accounts SPECIFIC products were discussed as an alternative to this product? Submissions require the NAMES of products and not just product types.*
  • What specifically about this product motivated you and the client to choose it?*

  • Additional Deposits (Account/Funding Details)

  • ORIGINATING Account Type:*
  • Receiving Account Type:*
  • ORIGINATING Account (Close or remains open?)*

  • Distributions - IMPORTANT - to ensure that the client & the team are clear on CURRENT distributions due to change, & NEW distribution details.
    Note - the timing of account opening and funding may disrupt a clients current routine for distributions. Please advise of an interim plan for distribution(s) from another account, if needed, to keep the clients income expectations on track while new account processes are in motion.

  • Does the RECEIVING account need to be setup for routine distributions?*
  • Rows
  • Will the money movement impact already established routine distribution in the ORIGINATING or RECEIVING account?*
  • Rows

  • Additional Deposits (Duty of Care)

  • Is the money coming FROM an annuity and going TO an annuity?*

  • Additional Deposits (Reasons for recommending this annuity)

  • Main Reason for Recommendation:*
  • 2nd Reason for Recommendation:
  • 3rd Reason for Recommendation:
  • How long does the client intend to own the proposed product?
  • Does the client plan to take income from the proposed annuity?

  • Suitability Supplement

  • Do the client's total annuity holdings exceed 60% of their total investable assets?*
  • Is client 70 years of age or greater?*
  • Is client 45 years of age or younger?*

  • Section A - Required if annuity holdings exceed 60% of total investable assets or client is age 70+

  • Rows

  • Section B - Required if client is 70 or older

  • Is client aware of all applicable maximum age limitations for the guaranteed benefit values involved?
  • Lifetime Withdrawal Rider - Is client aware that principal has to be depleted before the rider provides additional guaranteed value? (WD benefits typically require up to 15 - 20 years to recognize additional returns due to max WD restrictions)
  • Was anyone else involved in this investment decision?

  • Section C - Client 45 or Younger

  • If the client's employment situation changed, will they need to access cash values from this annuity beyond the product and IRS restrictions?
  • Does the client have the option to contribute to an ESP?
  • Is the client current contribution to an ESP?
  • Will the client be making continuing contributions to this annuity?
  • Should be Empty: