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Home
Agent Tools
Doing Business with DIL
Needs Analysis
Life Quotes
LTC | DI | Annuity Quotes
Underwriting Forms
XRAE Underwriting Tool
Underwriting Tools
Contracting & Licensing
Policy Service
Core Carriers
Sales & Marketing
Annuity
Disability
Long Term Care
Life Insurance
About
About Us
Meet the Team
Contact Us
Your Life Department
Annuity Quote Request
Annuity Quote Request
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Agent First Name
Agent Last Name
Agent License #
Agent Email
Annuitant First Name
Date of Birth
Gender
Male
Female
Annuitant Last Name
State of Residence
- Select -
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Risk Class
-Select-
Unknown - need assistance to determine
Preferred Best
Preferred
Standard Plus
Standard
Rated - Impaired Risk
Annuity Type
Single Premium Deferred - A one-time premium deposit only
Flexible Premium Deferred - multiple premium deposits will be made
Single Premium Immediate - a one-time premium deposit and income payments to annuity holder
SPDA Options
Multi-Year Guarantee - crediting rate is fixed for a set period of time
Fixed Rate - crediting rate is set annually by company
Indexed - crediting rate is determined index performance
Surrender Charge Period
3 years
4 years
5 years
6 years
7 years
8 years
9 years
10 years
More than 10 years
Guaranteed Crediting Rate Period
3 years
4 years
5 years
6 years
7 years
8 years
9 years
10 years
Initial Premium Amount
Premium Type
Qualified - IRA, 401k, Pension, etc.
Non-Qualified - after tax money
Cost Basis
Future Premiums
SPIA options
Life Only with NO period Certain
Life with Cash Refund
Life with Installment Refund
Life with Period Certain
Period Certain
Other - indicate in remarks
Period Certain Options
5 years
10 years
15 years
20 years
Other - Indicate in Remarks
Frequency of Income Payment
-Select-
Monthly
Annually
Quarterly
Semi-Annually
Date of First Payment
Remarks
Information Summary
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