| Applicant Information: ID# 656254 |
| Name: XXXX XXXXXXXX Gender: XXXXXXXX Birth date: 12/14/48 |
| Address: XXXXX XXXXXXXXXX XXXX City: Jacksonville State: Florida Zip: XXXXX |
| Work Phone: XXX-XXX-XXXX Home Phone: XXX-XXX-XXXX Best Time To Call: 8-10 a.m. |
| E-mail Address: xxxxxx@earthlink.net |
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| Quote Information: |
Investment (Funds) Information |
| Are you requesting for yourself? Yes |
Amount of money that you wish to invest: 750,000.00 |
| If no, who is request for? Me |
Is this a lump sum? Yes |
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If "No" how much do you plan to add later? N/A |
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How often do you plan to deposit additional funds? Annually |
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| Your Personal Tax Information: |
Your concerns: |
| Your tax bracket: 39% |
Primary reason for annuity purchase: Retirement |
| Funds from a Tax Qualified Account? Yes |
Other reasons for annuity purchase: Interest Rate |
| If "Yes" what type of account? 401K |
How long would you like your Annuity to grow? 10+ years |
| Funds from a Non Tax Qualified Account? No |
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| If "Yes" what type of account? N/A |
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| If a "CD", the month the CD comes due? N/A |
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