Bell & Associates | Life Insurance Specialists

800.308.BELL

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Client #1
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Tobacco Use : 
Client #2
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Plan Type  Individual Universal Life
   Survivorship Universal Life (2nd to Die)
   SPIA & UL Combination (Arbitrage)
Primary Objective  Maximum Guaranteed Death Benefit
   Maximum Death Benefit (Guarantees Not Essential)
   Cash Accumulation / Minimum Death Benefit
   Income - Arbitrage Strategy
   Maximum Death Benefit - Arbitrage Strategy
Premium Amount (if known) Lump Sum/Single Premium or 1035 Exchange
  Level Premium Amount
  Premium Mode
 Annually   Monthly 
  Paid Through Age
Death Benefit Amount (if known)
  Carries Through Age
Long Term Care (if available)
1035 Exchange
Non Qualified Money
Qualified Money (IRA, 401k, 403b)
Insurance Company Desired
Illustration Desired Simple Number Page / Ledger Full Multi-page Illustration
Special Illustration Instructions
Medical conditions / Surgeries / Diseases
Medicines Being Taken By Client
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