Annuity Illustration Request Date Requested* Month Day Year Agent's Email* Client's Name* First and Last Client DOB* Month Day Year Lump Sum 1* Qualified or Non-Qualified*Qualified (401K, IRA, etc.)Non-Qualified (savings account, cash, etc.)Lump Sum 2 (if none, enter N/A)Qualified or Non-QualifiedQualified (401K, IRA, etc.)Non-Qualified (savings account, cash, etc.)N/ALump Sum 3 Qualified or Non-QualifiedQualified (401K, IRA, etc.)Non-Qualified (savings account, cash, etc.)N/AWhat is the client’s primary goal?*Cash accumulationIncomeWhat length of contract does the client want?* 5 years 7 years 10 years 15 years When does client want income to start?* Immediately 5 years 7 years 10 years How frequently does the client want to be paid?* Monthly Annually Δ
