Illustrations

AMS For Life Illustration Request Form
You may either contact our product specialists at 866-546-5267 Option 1, or complete the illustration request form below. Fields marked with (*) are required.

Needed*
/ /
Agent*



E-Mail*
Phone*
 

Illustration Data

Client Name*
Spouse Name
   
Age*
or...
Age
or...    
DOB
/ /
DOB
/ /    
Sex*
Sex
   
   
Company(ies)


Insured No. 1 Rating

Best Available
No Tobacco

Preferred
Tobacco

Standard
Other Tobacco


Insured No. 2 Rating

Best Available
No Tobacco

Preferred
Tobacco

Standard
Other Tobacco


State


Objective


Product*

Survivorship
Term 10
ROP Term 15

UL
Term 15
ROP Term 20

Whole Life
Term 20
ROP Term 30

EIUL
Term 30

 

Death Benefit*
Desired Premium
   
If 1035 Exchange, Rollover Amount
Show Income at Age
   
Illustrate for No. of Years
Impaired Risk?
   
Comments
Please type the word displayed in the image*

   
 


Note: If submitting multiple illustration requests, please use your
brower's BACK button after you press SUBMIT REQUEST.
This will bring you back to the prior screen.