A Easy Fact Finder - Generic
Type of insurance you would like to apply for
Do you know which disability insurance company/product you would like to apply for?
Do you know which term life insurance company/product you would like to apply for?

Data from Life Insurance Quote Tool

Personal Information

(no initials, type NONE if applicable)
Have you had a name change or last name change?
Have you had a name change or last name change?
Check the box if you do not have a valid driver's license.

Personal Questions

Home Address (physically where you are standing/living right this minute)

Have you lived at this address for at least 2 years?

Mailing Address

Section

Are you moving in the next 90 days?

Employment Information

Please be specific and list specific manual duties that are performed on a daily basis.
We are looking to use the Unisex priced Multi-Life discount program from Principal for you if possible. This is the largest discount in terms of net percentage of premium that exists in the disability insurance market today. It is not available to all but we will try to get it for you.

IMPORTANT: Principal requires us to submit the application to them along with the following if we want to have the discount honored when it is approved:

FEIN (Federal Employer Identification Number) - This can usually be found on a W2. It can also be obtained from someone at your company. It is actually available publicly so let us know if you cannot find it. We can attempt to search for it.

Employer Name
Employer Address

The FEIN is not required in this form to submit it. We understand that you might need to look it up so feel free to send that along after this easy fact finder is done. You will also get an automated email from us that you can reply to with the information that we need for the discount.

include approximate dates and outcomes

Carrier Specific Questions - Guardian Disability Insurance

Carrier Specific Questions - John Hancock

Beneficiary Details

Note: beneficiaries and percentages can be updated or changed any time you like once a policy is in force
The carrier you are applying for requires this, if you would like us to follow up via secure email or a cal, please put XXX-XX-XXXX here

Information for in force life insurance

Policy Design - Life

Policy Design - Disability

Increase occurs on the anniversary of each year while disabled

Future Increase Options - Policy Details

Maximum file size: 134.22MB

Maximum file size: 134.22MB

Maximum file size: 134.22MB

Replacement Details - Disability

If you are replacing another disability insurance policy, there will be additional forms that will need to be signed.

Premium Payor Details

Please ask your employer how they plan to treat the payments that are made on your behalf

Financial Information

Maximum file size: 134.22MB

We commonly run multiple proposals and designs for disability insurance. This field can help us all to quickly identify the specific plan that you are interested in.
We always love letting the referring person know how much we appreciate spreading the word about what we do here at Insuring Income. Thank you from all of us.

This fact finding form is intended only as a tool to collect information to assist the agent and client to begin the application process with your desired insurance company for the insurance product stated in your state of residence. Information is never sold to 3rd parties or utilized beyond this purpose. This form is not an application for insurance and in no way is this form a solicitation for insurance. Each company ultimately has its' own application forms. We will work with the client to submit a formal application for insurance.

By providing us with your email address and phone number, you agree to receive electronic communications in the form of emails and text messages. These communications will be to confirm receipt of the form submission as well as to inform you of various steps in the process. Reply STOP at any point to opt out.