Online Application

Online Application

Our application should take 15-30 minutes to complete. We use 256-bit SSL technology, encryption, and Two-Factor authentication for your security. Insurance companies require financial questions to ensure an annuity is a good fit for you. We'll contact you 1-2 business days after reviewing your application to confirm any details before completing the company's application. We will send you the final insurer application to review and sign before submitting it to the insurance company.
Name*

First NameMiddle NameLast Name
What is your gender?*
Email*
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Zip Code
Primary Phone Number*
Please enter a valid phone number.
Backup Phone Number (Optional)
Please enter a valid phone number.
Birthday*

MonthDayYear
Date
What's Your Employment Status? *
Joint Owner (not available for IRAs and retirement accounts)
Why are you interested in this annuity? (Can select multiple answers)*

Guaranteed Interest RateFuture Retirement IncomeTax-Deferred GrowthEstate PlanningPass Assets To A BeneficiaryPrincipal ProtectionIncome Now

Investment Amount*
What company would you like to apply for?*
What interest rate are you interested in locking in? *
What term are you interested in? *
What's your most recent title or position? *
If retired - Ex. Retired Nurse
What's the joint owner's most recent title or position?
Skip if there is no joint owner
What's your marital status?*
What's your residency status?*
What's your tax filing status?*
Do you have dependents? List their age
How many years do you plan on keeping the annuity?*

Financial Experience *

What are your sources of income?*

Monthly Household Expenses (ex., Mortgage/rent, car, insurance, cost of living, etc.)*

Liquid & Non-Liquid Assets

Non-liquid assets can not be easily or quickly converted into cash.

How much do you have in each liquid asset? *

	Amount
Checking/Savings
CDs
Money Market
Stocks and Bonds
Mutual Funds
Retirement Savings (401k, IRA or Qualified Plans)

How much do you have in non-liquid assets? (Can't easily be turned to cash)*

	Value Of Non-Liquid Assets
Value Of Primary Home
Other Real Estate
Retirment Savings (non-liquid)
Gold, Silver
Antinques & Collectibles

Life Insurance Policies

	Company Name	Type Of Coverage	Total Cash Value	Is The Cash Value Subject To Penalties/Charges?
Policy #1
Policy #2
Policy #3

Annuity Policies

	Company Name	Type Of Annuity	Balance	Year Purchased	Subject To Surrender Charges/Penalties?
Annuity #1
Annuity #2
Annuity #3
Annuity #4
Annuity #5
Annuity #6
Annuity #7

Do you have an emergency fund for unexpected expenses?*

YesNo
How many months will your emergency fund last?*
Ex. Amount of emergency fund / Spending per month = # of months

Debts

What type of investments do you currently own?*

StocksBondsMutual Funds/ETFAnnuitiesLife InsuranceRental Real EstateGold/Silver
Do you live in a nursing home or skilled nursing facility? Or are you planning to enter one in the next 12 months? *
What is the owner's social security number?
What is the joint owner's social security number?
Ignore if there is no joint owner

Beneficiaries

Annuities bypass probate and transfer the funds based on the beneficiary you select. Your beneficiary will receive the accumulated value if you pass during the contract term. A primary beneficiary is required. You can elect a primary and contingent beneficiary, but a contingent beneficiary is optional. Beneficiaries should add up to 100%.

Beneficiary #1 *

	Beneficiary Information
Primary or Contingent
Gender
Full Name (First, Middle, Last)
Address
Birthday
Social Security Number (optional)
Telephone Number
Relationship to Owner
Percentage (Must be round number ex. 34%)

Beneficiary #2

	Beneficiary Information
Primary or Contingent
Gender
Full Name (First, Middle, Last)
Address
Birthday
Social Security Number (optional)
Telephone Number
Relationship to Owner
Percentage (Must be round number ex. 34%)

Beneficiary #3

	Beneficiary Information
Primary or Contingent
Gender
Full Name (First, Middle, Last)
Address
Birthday
Social Security Number (optional)
Telephone Number
Relationship to Owner
Percentage (Must be round number ex. 34%)

Beneficiary #4 (If you need more than four just contact us with the other information)

	Beneficiary Information
Primary or Contingent
Gender
Full Name (First, Middle, Last)
Address
Birthday
Social Security Number (optional)
Telephone Number
Relationship to Owner
Percentage (Must be round number ex. 34%)

Trust As Beneficiary (Ignore if you don't have a trust)

	Trust Information
Trust Name
Trust Type (Revocable Or Irrevocable)
Trust Name
Primary Or Contingent Beneficiary
Tax ID # or EIN (SSN for revocable trust and EIN for a irrevocable trust)

Questions?

Do you have any questions about the annuity or our process? If so, let us know, and we will reply in 24 hours.
Type a question

Driver's License or Passport

A copy of the front of your driver's license or passport is required for proof of identification. You can photograph your license with your phone, computer, or tablet camera. You can also upload an existing copy of your ID from your device.
Take Photo Of Driver's License Or Passport (if you didn't upload the file)
File Upload - Copy Of Driver's License Or Passport For Owners

You can also email a copy to support@annuityresources or fax to (866)831-4918
Cancelof
Should be Empty:

Liquid & Non-Liquid Assets