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Contracting
Existing Agents
Licensing Tools
New Agents
Products
Ancillary
>
Disability Insurance
Group Ancillary
Hospital Indemnity
Small Business Retirement Plans
Short-term Medical
Travel Insurance
Critical Illness
Dental, Vision & Hearing
Hybrid Life & LTC
Life & Annuities
>
Annuities
Term Life
Whole Life
LTC & Care Products
>
Long-Term Care
Home Care
Short-term Care
Medicare
>
Medicare Advantage
Medicare Supplement
Part D
Carriers
Carrier Selection
Forms & Materials
Incentives & Trips
Webinars
Quoting & Apps
Electronic Apps
iGo e-App
Medicare Center
Quote Requests
Quoting Tools
Underwriting
Marketing
Brochures
Email & Mail
Fact Sheets
Leads & Prospecting
Logos
Seminars & Webinars
Social Media
Websites
Tools & Training
Education & Training
Medicare Live
Secure File Upload
Tips of the Trade
Video Conference
Contact
About
Find Out More (FAQs)
Meet the Team
Testimonials
News
COVID19
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Client Information
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Indicates required field
Name of Annuitant
*
First
Last
Name of Joint Annuitant
*
First
Last
Date of Birth
*
Date of Birth
*
Gender
*
Male
Female
Gender
*
Female
Male
U.S. Resident?
*
Yes
No
U.S. Citizen?
*
Yes
No
Resident Country (if not U.S.)
*
Coverage Details
Type of Annuity Requested
*
Qualified (Pre-tax)
Non-qualified (After-tax)
Single Premium Deferred
Deposit Amount
*
1035 Funds
*
Yes
No
Multi-year Guarantee
Number of Years
*
Maximum Surrender Charge Period (# of Years)
*
Indexed
Indexed Maximum Surrender Charge (# of Years)
*
Bonus
*
Yes
No
Single Premium Immediate
Deposit Amount
*
1035 Funds
*
Yes
No
Agent Information
Agent
*
Phone
*
Email
*
Agency
*
City
*
State
*
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