LTC ILLUSTRATION REQUEST

REMINDER: 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 & GENERAL INFO

Advisor first name*

Advisor last name*

Email*

First & last name of person submitting the request

In addition to the advisor, is there anyone else who should receive the illustration (advisor's admin, for example)? If so, please list the email address.

Who is your Sales Development Advisor? *

SDA LTC illustration review? *

LTC case name or number (for your own tracking purposes)*

Any previous LTC illustrations run on this client? *

Is this LTC illustration part of a comprehensive case design? *

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

Rush LTC illustration request?*

Next Meeting Date*

Month/Day/Year

CLIENT DATA

Client first name*

Client last name*

LTC client gender*

Client date of birth

Month/Day/Year

Client age*

LTC client state*

LTC underwriting class *

Is this joint? *

LTC DESIGN

Preferred LTC carrier *

Preferred LTC product?

LTC design*

Solve for benefit (for example: $3k monthly LTC benefit)

Solve for annual premium paid for max LTC benefit (for example: $50,0000/annually LTC premium for 5 years)

LTC benefit duration

Premium years

Premium frequency

LTC inflation protection needed?

Any notes for this LTC request?

Upload additional attachments (if needed)