LIFE ILLUSTRATION REQUEST

REMINDER: Advisors CANNOT write annuity or life 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 & GENERAL INFO

Advisor first name*

Advisor last name*

Advisor email address*

First & last name of person submitting the request

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

Who is your Sales Development Advisor (SDA)?*

SDA illustration review? *

Case number or request name (for your reference)*

Is this part of a case design? *

Yes

No

I don't know

Is this a revision to an existing life illustration? *

Yes

No

How many life illustration iterations do you want to run for this client?*

Include ARIA?*

Yes

No

Is this a rush life illustration request? *

Next Meeting Date*

Please allow 1 to 2 business days

Month/Day/Year

CLIENT INFO

Client first name*

Client last name*

Client gender*

Client state*

Client age*

Client date of birth

Month/Day/Year

Client tobacco use?

Yes

No

Client underwriting class?

Super preferred

Preferred

Standard plus

Standard

Preferred tobacco

Standard tobacco

Special risk

Rating / flat extra

Do you have the spouse's information? (if applicable) *

Yes

No

FINANCIAL INFO

Total net worth

Total liquid net worth

Annual earned income

Tax rate percentage

ILLUSTRATION INFO

Insurance type*

IUL

GUL

UL

VUL

Whole life

Term

Carrier / product

Illustration objective

Max accumulation / income

Max death benefit

PREMIUM INFO

Total premium and divided over how many years?

For example: $300K total over 3 years

Annual premium for how many years?

For example: $100K annually for 3 years

TAX STATUS OF PREMIUM & DISTRIBUTIONS

Tax status of premium

Non-qualified

Qualified

Both

Change year or optimal?

Change year

Optimal

Show loans to pay taxes on qualified funds?

Income / loans to begin at what age or year?

Through age/ year?

Amount or solve?

1035 EXCHANGE

1035 amount

1035 basis

1035 loan

RIDERS

Choose riders (check all that apply)

PDA (3- to 10-year deposit)

Long-term care rider

Accelerated benefits

Income protection flex agreement

No-lapse guarantee

Something else

None

NOTES & ADDITIONAL ATTACHMENTS

Anything else we should know about this request? Add your notes here.

Upload additional attachments (if needed)