Pension Or Premium Finance Proposal

Proposal Request Type:

Producer Name:

Producer Phone:

Producer Email:

Client Name:

Client Phone:

Client Email:

Date Of Birth:

State:

Gender:

Smoker:

Health:

Requested Death Benefit:

Preferred Premium:

Net Worth:

Liquid Net Worth:

Annual Income:

Enter Pertinent Policy Design Specifics or Case Specifics:

Business Information

Producer    Client

Name of Business:

Tax Status:

Financial Professional:

Client Name:

Phone:

Email:

Date Business Began:

Date Of Incorporation:

Tax Year End:

State of Domiclie:

Approximate Contribution Desired:

% $ Maximum
(percent of pay or dollar amount)

Any current pension plan in force?

 
 
If so, please supply details:

Yes No Other:
(401(k), Defined Benefit, etc.)

IMPORTANT:
Do the owners have
ownership interests in
any other firms?

 

 

If so, please supply details:

Yes No

 

Details and Comments:

Employee Census

First Name Last Name % Stock
Owned
W 2
Compensation
Schedule C
-or-
K 1 Income
Annual
Hours
Worked
(if part time)
% $ $
Birth Date: / / Hire Date: / / Family Member of Owner?
% $ $
Birth Date: / / Hire Date: / / Family Member of Owner?
% $ $
Birth Date: / / Hire Date: / / Family Member of Owner?
% $ $
Birth Date: / / Hire Date: / / Family Member of Owner?

*Part-time is defined as working less than 1000 hours during a twelve month period.

Add More
First Name Last Name % Stock
Owned
W 2
Compensation
Schedule C
-or-
K 1 Income
Annual
Hours
Worked
(if part time)
% $ $
Birth Date: / / Hire Date: / / Family Member of Owner?
% $ $
Birth Date: / / Hire Date: / / Family Member of Owner?
% $ $
Birth Date: / / Hire Date: / / Family Member of Owner?
% $ $
Birth Date: / / Hire Date: / / Family Member of Owner?

*Part-time is defined as working less than 1000 hours during a twelve month period.

Add More
First Name Last Name % Stock
Owned
W 2
Compensation
Schedule C
-or-
K 1 Income
Annual
Hours
Worked
(if part time)
% $ $
Birth Date: / / Hire Date: / / Family Member of Owner?
% $ $
Birth Date: / / Hire Date: / / Family Member of Owner?
% $ $
Birth Date: / / Hire Date: / / Family Member of Owner?
% $ $
Birth Date: / / Hire Date: / / Family Member of Owner?

*Part-time is defined as working less than 1000 hours during a twelve month period.

Add More
First Name Last Name % Stock
Owned
W 2
Compensation
Schedule C
-or-
K 1 Income
Annual
Hours
Worked
(if part time)
% $ $
Birth Date: / / Hire Date: / / Family Member of Owner?
% $ $
Birth Date: / / Hire Date: / / Family Member of Owner?
% $ $
Birth Date: / / Hire Date: / / Family Member of Owner?
% $ $
Birth Date: / / Hire Date: / / Family Member of Owner?

*Part-time is defined as working less than 1000 hours during a twelve month period.

Add More
First Name Last Name % Stock
Owned
W 2
Compensation
Schedule C
-or-
K 1 Income
Annual
Hours
Worked
(if part time)
% $ $
Birth Date: / / Hire Date: / / Family Member of Owner?
% $ $
Birth Date: / / Hire Date: / / Family Member of Owner?
% $ $
Birth Date: / / Hire Date: / / Family Member of Owner?
% $ $
Birth Date: / / Hire Date: / / Family Member of Owner?