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Annuity Quote Request

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Financial Advisor

Advisor Name*

Client

Annuitant
Name*
MM slash DD slash YYYY
Gender*

Joint Annuitant
Name
MM slash DD slash YYYY
Gender
Use "Valued Client" on Quote*

Case Information

Financial Objective
Type of Annuity (check all that apply)
Payments to Start (enter number of years OR age if applicable)
Single/Joint (be sure to add additional annuitant above if Joint)
Surrender Charge Schedule (check all that apply)
Premium or Desired Income
Replacement

Additional Information

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