Annuity Illustration Request "*" indicates required fields Agent Name:* Casey Short Tony Rizzo Jay Beerley David McEntire Dan Thomas Please provide only companies in the A rated category. (A -, A+, etc.)Client Name* First Last Date of Birth* MM slash DD slash YYYY Gender* Male Female State of Residence:* Desired Premium Amount (Create an Illustration for Each)* $250,000 $200,000 $175,000 $150,000 $125,000 $100,000 $75,000 $50,000 Other Other Premium Amount Tax Qualification* Qualified Non-Qualified Roth Show RMD? Yes No Annuity Type* Fixed/Indexed Fixed No Preference Primary Objective of Annuity* Income (Typically a 10 Year Product) Accumulation (Length Varies) Death Benefit Select Product Period (More than one may be selected)* 5 years 7 years 10 years Other Other Product Period Single or Joint Payout?* Single Joint Spouse's Name* First Last Spouse's Date of Birth* MM slash DD slash YYYY Spouse's Gender* Male Female Income Option Level Increasing Please provide illustrations for both Create an Illustration for Each of the Following Immediate Income 1 Year Deferral 2 Year Deferral 3 Year Deferral 4 Year Deferral 5 Year Deferral 6 Year Deferral 7 Year Deferral 8 Year Deferral 9 Year Deferral 10 Year Deferral Additional Income Illustrations Notes:Index Allocation Comments:Do you have a preferred insurance company? Yes No These are my preferred companies, however I am open to any suggestions. Is this a Replacement?* Yes No Contract Value Surrender Value Surrender Percentage (anything over 10% would be a challenge but not impossible). Describe what the new product must offer to outperform the current productPlease provide any additional commentsPlease Create a Second Annuity for Roth Conversion No Yes Δ « Back to Workflow Seeds
