Face Amount *

Reason for selling policy *

Client Age & Sex *

Male age 74 or less/Female age 77 or less

Male age 75-78/Female age 78-81

Male age 79-83/Female age 82-86

Male age 84+/Female age 87+

Medical Condition *

Healthy

Has minor health problems

Health has changed considerably since policy issue

Client has developed serious medical issues

Policy Type *

Whole Life or Survivorship Whole Life

Term Life (must be convertible)

Universal Life or Variable Life

Survivorship Universal Life or Variable Survivorship Life

Joint Survivorship with one deceased

Cash Value as a Face Amount *

31% or greater

21% - 30%

16% - 20%

11% - 15%

6% - 10%

0% - 5%

Current Premium as a Percentage of death Benefit *

4.0%+

3.0% - 3.9%

2.0% - 2.9%

1.0% - 1.9%

Outstanding Loan as a percentage of Death Benefit *

31%

21% - 30%

11% - 20%

0% - 10%

Email *

Phone *

Comments

Candidate's Name

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