Agent Information:
First Name:
Last Name:
Annuitant Information:
Date of Birth: 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1933 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Gender: Male Female
Resident State: AK AL AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV OH OK OR PA PR RI SC SD TN TX UT VA VT WA WI WV WY
Product Selection:
Product: Single Premium Immediate Annuity (SPIA) ? Split Annuity ?
SPIA Policy Details:
Payout Options:
(select multiple)
Solve For: Income Proceeds
Tax Status: Non-Qualified Funds Qualified Funds
Tax Rate: 10% 15% 27% 30% 35% 38.6% Other Manual Tax Rate:
1st Payment: At Issue Date End of First Payment Period Other Date
Other Date: 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2024 2025
Mode: Annual Monthly Quarterly Semi-Annual
Proceeds Available:
Date of Issue: 4 5 26 27 28 29 30 1 2 2024
Cost Basis (Pre '86):
Cost Basis (Post '86):
SPIA Additional Policy Details:
Life Only:
COLA Rate: Select Rate 3 %
Period Certain:
Payout Options
Available
Options:
Selected
Period Certain + Life:
Joint to Survivor or Spouse:
Payable to Survivor or Spouse: 50% 60% 66.67% 75% 100%
Date of Birth: 1 2 3 4 5 6 7 8 9 10 11 12 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1934 1935 1936 1937 1938 1939 1940 1941 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024
Split Policy Details:
Split Concept: Traditional ? % Split ? Income ?
Total Premium:
Interest Rate: % Premium Return: 100 99 98 97 96 95 94 93 92 91 90 89 88 87 86 85 84 83 82 81 80 79 78 77 76 75 74 73 72 71 70 69 68 67 66 65 64 63 62 61 60 59 58 57 56 55 54 53 52 51 50 49 48 47 46 45 44 43 42 41 40 39 38 37 36 35 34 33 32 31 30 29 28 27 26 25 24 23 22 21 20 19 18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1
Payout Option: 10 Year Period Certain
Please specify date: 1 2 3 4 5 6 7 8 9 10 11 121 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 312024 2025
Tax Rate: 10% 15% 27% 30% 35% 38.6% Other