ILS Illustration Request - Why Cash Value Life Insurance

ILS Illustration Request Form

This form will be required to submit illustration requests to the home office

Agent Info:

First Name

Last Name

Agent Email

Client Info:

First Name

Last Name

Male / Female

Client Age / Date of Birth

Health Rating

Specifications:

Frequency the client would like to contribute

Funding Scenario #1 (Annual contribution and to what age)

Funding Scenario #2 (Annual contribution and to what age)

Funding Scenario #3 (Annual Contribution and to what age)

Target Death Benefit:

Target MEC Limit:

Additional Options:

If a 1035 Exchange will be involved, please specify the amount:

If you would like to see an income option, please select which scenario it will apply to:

If you would like to see an income option, please specify the year/age it should begin and the year/age it will end:

If you would like to see additional reports, please select from the list below:

Guaranteed Values IRR Report Other (Specify in the Notes below)

If the requested scenarios are needed by a certain date, please specify:

Notes: