Life Settlement Pre-Qualification Request

Please Complete the Form Below - Responses made in 24 Hours.

Policy Face Amount:*

Reason for selling policy:*

Client Age and Gender:*

*If Survivorship Policy - please select younger age.

Medical Condition:*

Policy Type:*

Cash Value as a Face Amount:*

Current Premium as a Percentage of Death Benefit:*

Outstanding Loan as a Percentage of Death Benefit:*

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.

If you are a Professional Advisor, please add your contact information below.

Name:

First Last

Email:

Phone: