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Personal Information
Name
Mainlnsured's Soc. Sec. #
Address
City
State
Zip
Property Address (if different from above)
City
State
Zip
Day Phone
Night Phone
Best Time To Call
Email Address
Occupation
Date of Birth
Type of Current Account
Current Account Balance
Penalty for Moving?
If yes, what % or $ amount
Is an upfront bonus important? (could cover surrender charge or market losses)
Federal Tax Status
Your Investment Objective - Please List all that apply: Income now, Flexibility, Tax deferral, Growth followed by income, Growth-possible income, Pass on to beneficiaries, Guarantees, Other)
With the exception of withdrawals (ie: required minimum distribution, systematic withdrawals of credits/interest, etc), how do you expect to take money out of this product?
When do you expect to take money out of this account
What is your source for this annuity’s premium