Bob Affronti - Mr. SPIA (Single Premium Immediate Annuity) web page
Home Up Feedback Contents Search

Agents
Immediate Annuity Product Design, Quoting, Training, Sales and Service 

JOIN

Agent SPIA Quote Request Form!
Please fill in as much information as possible.

Annuitant Information:
Name:   
Male  Female
D.O.B.  Age:   State:

Joint Annuitant Information (if any):
Name:    
Male   Female
D.O.B:  Age:   State: 

Source of Funds:
 Non- Qualified (cash, 1035 exchange etc.)
Qualified (Ira, 401K rollover, Pension etc.)

Deposit Amount: $
Desired Income: $
1035 Cost Basis  $

Deposit Date: Month Day Year

Income Start: Month Day Year

Annuity Payment Frequency:
Monthly Semi-Annually Quarterly Annually

Type of Immediate Annuity:
SINGLE LIFE
Life Only
Life With period certain of:
      5 Year 10 Years 15 Years 20 Years 
      Other: Years and   Months
 Life With Installment Refund 
Life With Cash Refund (low availability / none joint lives)

Joint LIFE
Joint & Survivor Lives ONLY
Joint With period certain of:
    5 Year 10 Years 15 Years 20 Years   
    Other: Years and   Months
Joint Percent To Survivor

Period Certain ONLY
   Period Certain Only for:
5 Year 10 Years 15 Years 20 Years
 Other:   Years and Months

Annual Inflation COLA:

Email: required
Phone: Appreciated
Fax: If you would like quotes faxed
Signing Agents Name
Requested by: (If other than agent)

Receive quotes by:
Email Adobe Acrobat PDF   Email Text
Fax Phone Call

Please use the comment for any special requests that do not appear on the form.
Comments - Requests - Referred By:

 

[ Home ] [ Up ] [ JOIN ]

Send mail to Webmaster@mrspia.com with questions or comments about this web site.
Copyright © 2005 Mr. SPIA
Last modified: 10/18/06