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| To Request a Personalized Proposal - Please E-mail the following information to:
mailto:dpotter@potterassociates.com (4 - Steps)
1.) "HIGHTLIGHT/COPY" this page" , 2.) then "PASTE" this page on the e-mail form, 3.) "FILL" in the Answers to the 5 Questions, and 4.) "HIT SEND") -
Proposed Insured's
Name_______________________, Age __, Health Status: [ ] Excellent, [ ] Good -
Proposed Beneficiary's
Name_______________________, Age___. Health: Status [ ] Excellent, [ ] Good -
Benefit: Income Amount $_________/month -
Must have your Contact Information: Phone # (___)__________,
Mailing Add: Street________________, Town___________, State___, Zip_____ -
Comment or Questions: Desired Benefit Option: (How do you want the income to be paid?)
Default: "Life Income"
[ ] Life Income: Income will be paid every month for life, terminating upon the
beneficiary's death. (this option will be the least expensive)
[ ] Life Income, with a 10 year Certain Period: The payout period is guaranteed
for 10 years.
[ ] Limited Income: Income to age 67, terminating when the insured's age would have been 67.
[ ] Limited Income: Income paid for the balance of 30 years. Desired Plan Options: (Do you want a level benefit or increasing benefit?)
Default: "Level Income Benefit"
[ ] Level income benefit, it does not change. (this option will be the least expensive)
[ ] 3% benefit increase every year, calculated from the date of policy issue.
[ ] 5% benefit increase every year, calculated from the date of the claim. Desired Premium Payment Options: (How do you want to pay for the protection)
Default: "Life Pay"
[ ] Life pay. (this option will be the least expensive)
[ ] 10-year pay - the policy is fully paid up thereafter
[ ] Single Premium - Paid-up no additional premium necessary
[ ] Premium paid to the insure's age of 67
[ ] Premium paid for 30 years There are several Riders available: (Not all are listed here)
Default: "None"
[ ] Premium Protection rider: (3 Options, dependent upon the company selected &
additional premium is required for this benefit)
1.] If the beneficiary dies first within the 1st 10 years, then the premium is refunded
to a living insured over 120 month and if the death occurs after 10 years the
refund is made over the same period as the premium was paid. (additional
premium is required for this benefit)
2.] If the beneficiary dies first, the premium is returned to the lnsured over 120
months.
3.] If the beneficiary dies first, there are two options; a.) 50% of the premium paid
will be return to the insured in a lump sum, or 2.) 100% of the premium paid is
return over 120 months. |
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