Annuity Income Research and Election (New & Existing Clients) "*" indicates required fields Client Name* First Last Client Name (If Joint) First Last Agent Name* Casey Short Tony Rizzo Jay Beerley David McEntire Dan Thomas Is this for research or income election?* Research Income Election Will the payment be single life or joint life?* Single Joint When do you want income to start?* MM slash DD slash YYYY Amount of tax you would like withheld?* NA/None 10% 15% 20% How many annuities are we researching?* 1 Annuity 2 Annuities 3 Annuities 4 Annuities What Insurance Carrier?*Last four digits of Policy Number?*What payment frequency would you like?* Monthly Annually Additional Comments or QuestionsAnnuity 1 - What Insurance Carrier?*Annuity 1 - Will the payment be single life or joint life?* Single Life Joint Life Please Research Both Joint and Single Annuity 1 - Income Election Preference* Income Election at a Specific Age Income Election for a Specific Date Immediate Income Election (or the next Bump Up Upon DOB or Anniversary) Multiple Income Election Start Times (ie Immediate, 1 year, 2 year, etc) Annuity 1 - Age (if joint, specify which spouse)*Annuity 1 - Income Election Date* MM slash DD slash YYYY Annuity 1 - What payment frequency would you like?* Monthly Annually Annuity 1 - Additional CommentsAnnuity 2 - What Insurance Carrier?*Annuity 2 - Will the payment be single life or joint life?* Single Life Joint Life Please Research Both Joint and Single Annuity 2 - Income Election Preference* Income Election at a Specific Age Income Election for a Specific Date Immediate Income Election (or the next Bump Up Upon DOB or Anniversary) Multiple Income Election Start Times (ie Immediate, 1 year, 2 year, etc) Annuity 2 - Age (if joint, specify which spouse)*Annuity 2 - Income Election Date* MM slash DD slash YYYY Annuity 2 - What payment frequency would you like?* Monthly Annually Annuity 2 - Additional CommentsAnnuity 3 - What Insurance Carrier?*Annuity 3 - Will the payment be single life or joint life?* Single Life Joint Life Please Research Both Joint and Single Annuity 3 - Income Election Preference* Income Election at a Specific Age Income Election for a Specific Date Immediate Income Election (or the next Bump Up Upon DOB or Anniversary) Multiple Income Election Start Times (ie Immediate, 1 year, 2 year, etc) Annuity 3 - Age (if joint, specify which spouse)*Annuity 3 - Income Election Date* MM slash DD slash YYYY Annuity 3 - What payment frequency would you like?* Monthly Annually Annuity 3 - Additional CommentsAnnuity 4 - What Insurance Carrier?*Annuity 4 - Will the payment be single life or joint life?* Single Life Joint Life Please Research Both Joint and Single Annuity 4 - Income Election Preference* Income Election at a Specific Age Income Election for a Specific Date Immediate Income Election (or the next Bump Up Upon DOB or Anniversary) Multiple Income Election Start Times (ie Immediate, 1 year, 2 year, etc) Annuity 4 - Age (if joint, specify which spouse)*Annuity 4 - Income Election Date* MM slash DD slash YYYY Annuity 4 - What payment frequency would you like?* Monthly Annually Annuity 4 - Additional Comments Δ « Back to Workflow Seeds
