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Home » Internal-Life Insurance- Existing Clients

Life Insurance Existing Clients

MM slash DD slash YYYY
MM slash DD slash YYYY
General Information
Client/ Dependent Name:
Amount Of Death Benefit:
Current Income:
State of Residence:
Date of Birth:
Are they a business owner? (Y or N)
If business owner, how many employees do they have:
 
Health Information
Client/Dependent Name:
Sex:
Height:
Weight:
Health Conditions
Medications
 
Are they a smoker?
Type Of Smoker:
Client Name
(Cigarettes, Cigar, Pipe, Vapor, Chew)
 
Current Coverage:
Client/Dependent Name:
Current Carrier of in-force coverage:
Current Coverage in Force:
Replace: (Y or N)
Group Coverage Benefit:
 

New Life Insurance

Premium Paid:
Premium:
Term:
WL Dividend Option:

Premium Paid:
Premium:
Term:
WL Dividend Option:

Premium Paid:
Premium:
Term:
WL Dividend Option:

Premium Paid:
Premium:
Term:
WL Dividend Option:

Shop Quotes Here:

Additional Life Insurance Tasks to be added to Salesforce:
Subject:
Assigned To:
Due Date:
Priority: (Low, Normal, High)
Notes:
 
This field is for validation purposes and should be left unchanged.

INTERNAL- Life Insurance- EC

Life Insurance Existing Clients

MM slash DD slash YYYY
MM slash DD slash YYYY
General Information
Client/ Dependent Name:
Amount Of Death Benefit:
Current Income:
State of Residence:
Date of Birth:
Are they a business owner? (Y or N)
If business owner, how many employees do they have:
 
Health Information
Client/Dependent Name:
Sex:
Height:
Weight:
Health Conditions
Medications
 
Are they a smoker?
Type Of Smoker:
Client Name
(Cigarettes, Cigar, Pipe, Vapor, Chew)
 
Current Coverage:
Client/Dependent Name:
Current Carrier of in-force coverage:
Current Coverage in Force:
Replace: (Y or N)
Group Coverage Benefit:
 

New Life Insurance

Premium Paid:
Premium:
Term:
WL Dividend Option:

Premium Paid:
Premium:
Term:
WL Dividend Option:

Premium Paid:
Premium:
Term:
WL Dividend Option:

Premium Paid:
Premium:
Term:
WL Dividend Option:

Shop Quotes Here:

Additional Life Insurance Tasks to be added to Salesforce:
Subject:
Assigned To:
Due Date:
Priority: (Low, Normal, High)
Notes:
 
This field is for validation purposes and should be left unchanged.

Contact Info

Scarlet Oak Financial Services
1117 Perimeter Center West,
Suite W-212
Atlanta, GA 30338

800.871.1219

fsykes@scarletoakfs.com

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Advisory services offered through Capital Asset Advisory Services, LLC, a Registered Investment Advisor. This site is published for residents of the United States only. Representatives may only conduct business with residents of the states and jurisdictions in which they are properly registered. Therefore, a response to a request for information may be delayed until appropriate registration is obtained or exemption from registration.

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    • For Business
    • For Personal Finances
    • For Tax Planning
    • For Estate Planning
    • For Everyone
  • About Us
    • Faye Sykes
    • Melinda Scaturro
    • Teresa Bath
    • Morgan Roopnarine
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    • Virtual Events
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