CASE DESIGN REQUEST

PLEASE READ FIRST: Request a case design for clients who need a more comprehensive plan. They may be looking for strategies to address multiple needs - including tax-free wealth, income, legacy and/or long-term care. Case designs account for income needs, existing income sources (such as pensions, employment and/or Social Security), as well as liquid net worth and cash flows.

Please allow 4 to 5 business days to complete your case design request. If you need an annuity, life or LTC illustration (or a revision to an existing illustration), go here.

Advisors CANNOT write apps without first being licensed in the state, appointed with the carrier and completing educational requirements. Need to complete product training? Please go here.

ADVISOR INFO

Advisor first name*

Advisor last name*

Advisor email*

First & last name of person submitting the request

In addition to the advisor, is there anyone else who should receive the illustration? If so, please list the email address and we'll be sure to send them the illustration.

Who is your Sales Development Advisor? *

Case design name or number (for your own internal purposes): *

Next client meeting date *

Month/Day/Year

CLIENT OBJECTIVES

What are the client's top three goals?

What type of solution are you looking for? (check all that apply)*

Life

Annuity

LTC

Something else

Does the client need retirement income? *

Yes

Any additional notes regarding client goals and/or plan objectives?

CLIENT INFO

Client first name*

Client last name*

Client gender*

Case design client state*

Client age*

Client date of birth

Month/Day/Year

Include spouse in case design? *

Yes

Who is insurable? *

Client

Spouse

Both

Neither of them

Retired? *

Yes

Current income *

Current tax rate *

FAMILY INFO

Number of children

Number of grandchildren

Any additional notes regarding the family?

ASSET INFO

Total net worth*

Total liquid net worth*

Non-qualified balance (investments, brokerage & savings)

401(k) account balance #1

401(k) ownership #1

401(k) account balance #2

401(k) ownership #2

IRA account balance #1

IRA ownership #1

IRA account balance #2

IRA ownership #2

Roth account balance #1

Roth ownership #1

Roth account balance #2

Roth ownership #2

Annuity account balance #1

Annuity ownership #1

Annuity account balance #2

Annuity ownership #2

Social Security monthly income #1

Social Security recipient #1

Social Security start age #1

Social Security monthly income #2

Social Security recipient #2

Social Security start age #2

Pension balance #1

Pension ownership #1

Pension monthly income #1

Pension start age #1

Pension balance #2

Pension ownership #2

Pension monthly income #2

Pension start age #2

Other monthly income (rental, for example)

Other monthly income recipient

Other monthly income start age

Any additional notes or assets to include?

LIFE INSURANCE IN FORCE

Does the client have any of the following life insurance in force? *

Permanent

Term

None

I don't know

Any additional notes related to existing life insurance?

ATTACH FACT FINDERS, DOCUMENTS & OTHER INFO

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