Your firsthand knowledge of the applicant is a crucial ingredient to good field underwriting.

Client Name:

Occupation & Duties:

How long employed in same occupation?

You are a key in the underwriting process

Self Employed?

Yes

NO

Work from Home?

Yes

No

Tobacco User?

Yes

No

Annual Earned Income/Net Income for Self-Employed

Prior Year's Taxable Income:

Plan Design:

Elimination Period?

30

60

90

180

1 yr

5 yr

Age 65

Benefit Period?

2 yr

10 yr

Benefit Amount?