Request a Proposal Protecting your client's income is a wise decision. While your client may already have life insurance, disability insurance can help balance their income protection plan by safeguarding their income if they become sick or injured and unable to work. What is your client's most valuable asset? If they are like most people, their most valuable asset is their income and their ability to earn a living. It is important that we get the details listed below on your client so that we can shop multiple carriers to find the best fit and value. Click here to learn about streamlining the underwriting process.HTML BlockAdvisor's Full NameAdvisor's Full NameAdvisor's Email Advisor's EmailAdvisor's Phone NumberAdvisor's Phone NumberAdvisor's Company NameAdvisor's Company NameNew Advisor to Secura ConsultantsYesNoNew Advisor to Secura ConsultantsClient Applying for: Personal Disability Insurance Business Disability Insurance Client Applying for:Request a Proposal for: Individual Disability Insurance Long Term Care Critical Illness & Accident Multi-Life & GSI Special Risk Disability Group Ancillary Plans Specialty Products & Program Request a Proposal for:Request a Proposal for: Overhead Expense Buy Sell Key Person Loan Indemnification Request a Proposal for:Client Also Applying for Life Insurance or Have in the Past 6 MonthsYesNoClient Also Applying for Life Insurance or Have in the Past 6 MonthsIf so, we may be able to coordinate some aspects of underwriting to make for a more streamlined process.HTML BlockClient’s Monthly Fixed CostsClient’s Monthly Fixed CostsHow much disability insurance your client needs depends on their finances, savings, and how comfortable they are with taking risks to save money on insurance. The biggest factors in the cost for disability insurance coverage are the monthly benefit and benefit period. If we know your client's monthly fixed costs and a reasonable premium target, we can create a policy that fits your client's needs. Knowing your client's meeting time allows us to prioritize requests and make sure you have what you need in a timely manner.HTML BlockAmount Client Needs Monthly in the Event of a DisabilityAmount Client Needs Monthly in the Event of a DisabilityReasonable Premium TargetReasonable Premium TargetClient's Full NameClient's Full NameAdvisor & Client Meeting DateAdvisor & Client Meeting DateClient's Company/Institution NameClient's Company/Institution NameKnowing where your client works allows us to research potential discounts available at their company/institution. If your client is a business owner, it helps to know the name of the business to be able to do some research and find the best solutions for your client.HTML BlockClient's StateClient's StateInsurance rates are state-priced and regionally priced.HTML BlockClient's GenderClient's GenderInsurance rates are formulated by gender.HTML BlockClient's Date of BirthClient's Date of BirthInsurance rates are formulated using age.HTML BlockClient's Tobacco UseClient's Tobacco UseInsurance rates are formulated by tobacco usage.HTML BlockClient's Annual Income (list all sources for the last 2 years)Client's Annual Income (list all sources for the last 2 years)Insurance amounts are based on NET income (for business owners, income after expenses; for W2 employees it is total gross income).HTML BlockClient's Inforce Disability Coverage?Client's Inforce Disability Coverage?This policy will coordinate with any inforce DI coverage your client may already have in place. If your client has group coverage through their employer we will want to know the replacement %, benefit cap, and taxability of the coverage including who pays for the coverage.HTML BlockClient's Occupation and Job Duties?Client's Occupation and Job Duties?Your client's job title and job duties will determine your occupation classification (similar to a life insurance rating) If your client is a business owner, we need to know # of employees, years of ownership, % of ownership, and a breakdown of daily duties. This information can drastically change the premiums and discounts available. Include average hours worked per week.HTML BlockClient's Height/Weight, Health History/Concerns, Medications/Dosages, and Hobbies/Exercise Routine?Client's Height/Weight, Health History/Concerns, Medications/Dosages, and Hobbies/Exercise Routine?Underwriting for disability insurance is often different from other forms of insurance. Underwriters take into consideration medical, occupational and financial information when underwriting disability insurance. It is important that the advisor confirms as much information as possible about a prospect prior to the development of quotes in order to deliver accurate coverage and to prevent unpleasant surprises during underwriting.HTML BlockUpload client files such as financial statements, existing policies, medical records, etc. Drop files here or Upload client files such as financial statements, existing policies, medical records, etc.CaptchaCaptcha This iframe contains the logic required to handle Ajax powered Gravity Forms.