SPIA Quote Request Form

Agent Info:
First Name
Last Name
Email
Phone
Annuitant Info:
Name
Date of Birth / Age
Gender	Male Female
State of Issue
Join Annuitant Info (if Joint SPIA):
Name
Date of Birth / Age
Gender	Male Female
Continuation %
Quote Information:
Type of SPIA
Impaired Risk SPIA
Income Options
Certain Period
Inflation COLA
Solve For	Premium Income
Premium
Income
Cost Basis
Tax Status	Qualified Non-Qualified
Mode of Payment
Deposit Date
Start Date
Additional Comments

Use the Policy Assessment Kit to create unbiased, third-party support for addressing your client's underperforming policies.

2/08	ING's New Benchmark Strategy
2/15	Policy Assessment Webinar

Agent Info: