Case Design Fact Finder
ADVISOR INFORMATION
Advisor Name
*
First Name
Last Name
Advisor Email
*
example@example.com
Advisor Phone Number
*
-
Area Code
Phone Number
Who is your SVP / Recruiter?
(if known)
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Case Design Fact Finder
CLIENT INFORMATION
PROPOSED INSURED #1
CLIENT 1
Client 1 Name
*
First Name
Last Name
Client 1 Sex
*
Please Select
Male
Female
Client 1 Age or DOB
*
Client 1 State
*
Please select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Client 1 Class / Health Issues
*
Client 1 Tobacco / Marijuana Use
*
Please Select
None
Cigarettes
Other (chew, gum)
Marijuana
Is there a second proposed insured?
*
Please Select
Yes
No
PROPOSED INSURED #2
CLIENT 2
Client 2 Name
*
First Name
Last Name
Client 2 Sex
*
Please Select
Male
Female
Client 2 Age or DOB
*
Client 2 Class / Health Issues
*
Client 2 Tobacco / Marijuana Use
*
Please Select
None
Cigarettes
Other (chew, gum)
Marijuana
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Case Design Fact Finder
INSURANCE OBJECTIVES
Product Type(s)
*
Term
Universal Life (UL)
Variable UL (VUL)
Indexed UL (IUL)
Whole Life (WL)
Survivorship UL (SUL)
Survivorship VUL (SVUL)
Hybrid / Asset Based
Long Term Care (LTC)
Death Benefit Goal
*
Premium Goal
*
What are the proposed insured's objective for coverage?
*
(Ex: lower premiums, extended guarantees, increased face, etc)
Is there existing coverage being replaced?
*
Please Select
Yes
No
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Case Design Fact Finder
COVERAGE TO BE REPLACED
Product Type
Death Benefit
Premium
Cash Value
Loan Balance
Other issues that may impact replacement
(Ex: riders, changes in health, multiple policies, need to change product type, etc)
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Case Design Fact Finder
ADDITIONAL CONSIDERATIONS
Areas that may need additional planning
(Ex: business case, ILIT ownership, gifting issues, etc)
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