Life Settlement Pre-Qualification Request

[vc_row][vc_column][vc_column_text css=”.vc_custom_1531832412464{margin-bottom: 0px !important;}”]

[/vc_column_text][/vc_column][/vc_row][vc_row][vc_column]

Please Complete the Form Below - Responses made in 24 Hours.
Policy Face Amount:*
Reason for selling policy:*
Client Age and Gender:*
- Male age 74 or less / Female age 77 or less
- Male age 75-78 / Female age 78-81
- Male age 79-83 / Female age 82-86
- Male age 84+ / Female age 87+
*If Survivorship Policy - please select younger age.
Medical Condition:*
- Healthy
- Has minor health problems
- Health has changed considerably since policy issue
- Client has developed serious medical issues
Policy Type:*
- Whole Life
- Term Life (must be convertible)
- Universal Life
- Survivorship Life
Cash Value as a Face Amount:*
- 31% or greater
- 21% - 30%
- 16% - 20%
- 11% - 15%
- 6% - 10%
- 0% - 5%
Current Premium as a Percentage of Death Benefit:*
- 4% +
- 3% - 3.9%
- 2% - 2.9%
- 1% - 1.9%
- < 1%
Outstanding Loan as a Percentage of Death Benefit:*
- 31%
- 21% - 30%
- 11% - 20%
- 0% - 10%
Name:*
First Last
Email:
Phone:
Comments / Special Considerations:
Policy Information Upload
Drop files here or

Max. file size: 512 MB.
If you have any policy information, please upload here.
Advisor Information
If you are a Professional Advisor, please add your contact information below.
Name:
First Last
Email:
Phone:

[/vc_column][/vc_row]

Services