paperwork - precoa
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PRECOA - TheCompletePreneedCompany
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P A P E R W O R K• Workbook •
PRECOA - TheCompletePreneedCompany
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PRECOA - TheCompletePreneedCompany
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DoWnloaD rate carD & calculator
Online Rate Calculator
Links are located on the resource tab of the counselor portal or on the funeral home portal (www.precoa.com/fh)
Excel Rate Calculator
Download from the resource tab on the counselor portal or from the
funeral home portal (www.precoa.com/fh)
Paper Rate Card
Download from the “Order Supplies” section on the Resource Tab of the
Counselor Portal.
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use the rate card to answer the following: What is the oldest someone can elect to do a standard 3-year pay plan? ____________ graded? ____________
What is the oldest someone can elect to do a standard 5-year pay plan? ____________ graded? ____________
What is the oldest someone can elect to do a standard 10-year pay plan? ____________ graded? ____________
What is the oldest someone can elect to do a standard 20-year pay plan? ____________ graded? ____________
Does an 81-year-old unhealthy person qualify for 10-year plan? ____________ 20-year plan? ____________
What is the graded death benefit during the 1st year of a 5 year plan? __________________________
What is the graded death benefit during the 2nd year of a 10 year plan? __________________________
What is the graded death benefit during the 3rd year of a 20 year plan? __________________________
What is the minimum initial face amount? ____________ minimum down payment? ____________
What is the maximum initial face amount? ____________ maximum down payment? ____________
Over 1 year, how much extra will a policy owner pay if doing a monthly direct bill? ______________
Over 1 year, how much more will a policy owner pay if doing a quarterly direct bill? ______________
Over 1 year, how much more will a policy owner pay if doing a semi-annual direct bill? ______________
Over 1 year, how much more will a policy owner pay if doing an annual direct bill? ______________
An insured who answers “yes” to the first health question will be placed on which benefit determination? ______________
An insured who answers “no” to all of the health questions will be placed on which benefit determination? _____________
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App Exercise 1-Alice: Age 58, Single Premium, $3,995 FA (face amount), Healthy
App Exercise 2-Brandon: Age 83, 10 yr., EFT, $8,000 FA, Healthy
App Exercise 3-Christy: Age 72, 20 yr., EFT, $6,500 FA, $1,500 DP (down payment), Healthy
App Exercise 3a-Jamie: Age 72, 20 yr., EFT, $6,500 FA, $1,500 DP (down payment), Healthy, Include 1st month’s premium
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App Exercise 4-Debra: Age 75, $8,967 FA, 10 yr., Semi-annual, Healthy
App Exercise 5-Elizabeth: Age 68, $3,900 FA, 10 yr., annual, $2,100 DP
App Exercise 6-Frank: Age 54, $5,297 FA, Dying of Cancer (TI)
App Exercise 7-George: Age 67, $2,900 FA, 20 yr., Direct Bill, Stroke 2.5 years ago (no current medication)
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App Exercise 8-Harriot: Age 85, $3,400 FA, 10 yr., EFT, wants to pay $350 today
App Exercise 9-Ian: Age 62, 10 yr., EFT, Healthy, Can only afford $55/month
App Exercise 10-Justin: Age 85, $5000 FA, 10 yr., EFT, $2,000 DP, Healthy
App Exercise 11-Katie: Age 29, $5000 FA, 10 yr., EFT, $2,000 DP, Healthy (compare with Justin)
PRECOA - TheCompletePreneedCompany
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DaviD G. Barnes
Contact Information
David G. barnes
153 Meadow View Drive
Hartford, ct 06103
860-545-6307
Pass: ahW6Quaej1
DOB: January 30 (62 years old)
Visa: 5224 5632 1178 0362
Exp: 8/2013
SSN: XXX-XX-4037
Occu: General contractor
Beneficiary: Harvey barnes (son)
Blood: A+
Weight:182.4 lbs
Height: 6’ 0”
Health: Healthy
beg inner
backGrounDDavid Barnes is a 62 year-old from Hartford, CT.
He fought in Vietnam and is now retired. He lost his wife unexpectedly
earlier this year and they had never discussed her final wishes. David is
still questioning whether or not he did the right thing.
David filled out the survey from the Funeral Home because he was
interested in finding a place where he could record his final wishes so
they are met in every detail. David is very particular about his funeral
plans.
concernDavid heard about preplanning from a colleague from the
Rotary Club but doesn’t quite see the need because of his
large life insurance policy.
Funeral PreFerencesHe incurred quite an expense paying for his wife’s funeral
and has chosen to fund his $4,300 cremation over a 10 year
EFT. Although David wants to be cremated he would like
to have some type of service. He would like payments to be
withdrawn on the 11th of the month.
PRECOA - TheCompletePreneedCompany
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3000PN-I-KY 06-11 WHITE COPY - Insurance Company YELLOW COPY - Funeral Firm/Producers PINK COPY - Family
APPLICATION FOR INSURANCE/ANNUITY National Guardian Life Insurance Company (NGL)
Phone 800.988.0826 - Fax 866.228.9927 Two East Gilman Street - PO Box 1191 - Madison WI 53701-1191
1. REQUIRED: Have you been diagnosed by a physician with a terminal illness or are you receiving hospice care?
2. Are you confined to a bed, hospitalized, scheduled for surgery requiring an overnight hospital stay, or receiving skilled nursing care; OR within the past two (2) years, have you had, been diagnosed with, or received treatment (including medication) by a medical professional for any of the following: stroke, organ transplant, cancer (other than skin), immune system disorder; OR within the past one (1) year, have you had, been diagnosed with, or received treatment (including medication) by a medical professional for any of the following: COPD (Chronic Obstructive Pulmonary Disease), emphysema, chronic heart disease, congestive heart failure, or cirrhosis of the liver, kidney/renal failure, kidney dialysis, Alzheimer's disease, ALS (Amyotrophic Lateral Sclerosis) or amputation due to disease? Multipay Plan: If NO on question 1 and YES or not answered to question 2, death benefit will be limited. If YES on question 1 or not answered, an Annuity is available.
4.
1.First Name MI Last Name Male
Female
Date of Birth Age SSN
POLICY OWNER'S INFORMATION (If other than proposed insured)First Name MI Last Name Relationship SSN
3. MAILING ADDRESS (For delivery of policy and billings)Address
Secondary Phone Number
State
Primary Phone Number
IRREVOCABLE ASSIGNMENT (Initial only if the Policy should be irrevocably assigned.)9.
I elect to assign this Policy subject to the terms of the Irrevocable Assignment of Policy on the last page of this form.
Owner Initials
Yes No
Yes No
REPLACEMENTYes NoYes NoYes NoYes No
7.APPLICANT REPLACEMENT - Do you have any existing insurance policies or annuity contracts? Will the insurance applied for replace or change any insurance or annuity now or recently in force? If "Yes", complete required replacement form(s). AGENT REPLACEMENT - Does the applicant have any existing insurance policies or annuity contracts? Will the insurance applied for replace or change any insurance or annuity now or recently in force?
To the best of my knowledge and belief, the above information is true and complete. I understand that no insurance will be effective until this form is approved and the Policy is issued while the Insured is living. I authorize NGL to share my nonpublic personal information with any Funeral Provider with whom I have a Prefunded Funeral Agreement. If I am the Owner for insurance on the life of the Proposed Insured, I certify that I have an insurable interest in his or her life. If Monthly EFT is selected, the Insured and/or Owner authorize the withdrawal of all premiums due from the account provided. I acknowledge that I have read all information on the last page of this form.
8. SIGNATURES AND POLICY OWNER'S STATEMENT
Signature of Proposed Insured X Signature of
Policy OwnerCity & State Date
10. PRODUCER'S STATEMENT AND SIGNATUREAGENT'S STATEMENT: The Insured's signature personally witnessed by an agent for the company. I certify that any information recorded by me on this form is true and accurate to the best of my knowledge. Only insurer approved sales materials were used in conjunction with this sale, copies of which were left with the applicant.
Appointment Code
Signature of Producer
Printed Name of Producer
Producer Number
WAS WAS NOT
Zip
2.
City
PROPOSED INSURED'S INFORMATION
HEALTH QUESTIONS (Addressed to proposed insured)
5.
Face and Payment Amount Information
Payment Date (1-28th)
Monthly EFT - Total First Payment and ongoing Monthly Payments (include voided check)
Payment Mode Single Pay EFT From Checking
Montly EFT - Total First Payment ONLY (include voided check/one-time withdrawal)
Multi Pay EFT From Checking
Complete Payment Authorization Form
Single Pay
Available Plans
3 Year Pay
5 Year Pay
10 Year Pay
20 Year Pay
Annuity Other Payment Options
6. DIRECTIONS FOR PAYMENT OF PROCEEDS (Do not complete until you have read the last page of this form for important information)Name of Funeral Provider
Zip Beneficiary (other than Funeral Firm)
Relationship
PLAN AND PAYMENT DETAILS
Face Amount Monthly Payment Amount Payment Today
Single Pay $ $
Multi Pay $ $ $
Total Face Amount $_____________________ Total First Payment $ ____________________
PRECOA - TheCompletePreneedCompany
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Kathleen j. Frazier
Contact Information
kathleen J. Frazier
4000 apple lane
Davenport, Il 52807
309-269-7350
Pass: longeesoh4Z
DOB: January 15 (57 years old)
Visa: 4556 0003 7417 7343
Exp: 7/2011
SSN: XXX-XX-3900
Occu: chemist
Beneficiary: cheryl stevens (sister)
Blood: b+
Weight:170.1 lbs
Height: 5’ 5”
Health: kathleen is healthy. she is
a cancer survivor of five years. she
takes no continual treatment.
beg inner
backGrounDKathleen Frazier is a 57 year-old widow from Davenport, IL.
Three years ago her husband passed away and left her and
the children struggling for answers even though the cost
was bearable. Kathleen and her husband didn’t spend any
time discussing funeral arrangements and it was hard on
her.
Kathleen completed a survey sent by the Funeral Home because she
was interested in receiving a Final Wishes Organizer. She doesn’t want
her children to have to go through the same emotional struggles that
she did. She wants all the details to be planned so her children don’t
have to wonder what it is that she wants.
concernAlthough she wants her funeral details planned she is
nervous about purchasing a policy because she may end
up moving back to her hometown of Chicago.
Funeral PreFerencesKathleen would like a traditional service with a viewing.
She wants to make a $2,100 down payment to her $7,500
funeral. She would like to pay the remaining amount
($5,400) on a 10-year automatic withdrawal. Kathleen
would like payments to be withdrawn on the 5th of the
month.
PRECOA - TheCompletePreneedCompany
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3000PN-I-KY 06-11 WHITE COPY - Insurance Company YELLOW COPY - Funeral Firm/Producers PINK COPY - Family
APPLICATION FOR INSURANCE/ANNUITY National Guardian Life Insurance Company (NGL)
Phone 800.988.0826 - Fax 866.228.9927 Two East Gilman Street - PO Box 1191 - Madison WI 53701-1191
1. REQUIRED: Have you been diagnosed by a physician with a terminal illness or are you receiving hospice care?
2. Are you confined to a bed, hospitalized, scheduled for surgery requiring an overnight hospital stay, or receiving skilled nursing care; OR within the past two (2) years, have you had, been diagnosed with, or received treatment (including medication) by a medical professional for any of the following: stroke, organ transplant, cancer (other than skin), immune system disorder; OR within the past one (1) year, have you had, been diagnosed with, or received treatment (including medication) by a medical professional for any of the following: COPD (Chronic Obstructive Pulmonary Disease), emphysema, chronic heart disease, congestive heart failure, or cirrhosis of the liver, kidney/renal failure, kidney dialysis, Alzheimer's disease, ALS (Amyotrophic Lateral Sclerosis) or amputation due to disease? Multipay Plan: If NO on question 1 and YES or not answered to question 2, death benefit will be limited. If YES on question 1 or not answered, an Annuity is available.
4.
1.First Name MI Last Name Male
Female
Date of Birth Age SSN
POLICY OWNER'S INFORMATION (If other than proposed insured)First Name MI Last Name Relationship SSN
3. MAILING ADDRESS (For delivery of policy and billings)Address
Secondary Phone Number
State
Primary Phone Number
IRREVOCABLE ASSIGNMENT (Initial only if the Policy should be irrevocably assigned.)9.
I elect to assign this Policy subject to the terms of the Irrevocable Assignment of Policy on the last page of this form.
Owner Initials
Yes No
Yes No
REPLACEMENTYes NoYes NoYes NoYes No
7.APPLICANT REPLACEMENT - Do you have any existing insurance policies or annuity contracts? Will the insurance applied for replace or change any insurance or annuity now or recently in force? If "Yes", complete required replacement form(s). AGENT REPLACEMENT - Does the applicant have any existing insurance policies or annuity contracts? Will the insurance applied for replace or change any insurance or annuity now or recently in force?
To the best of my knowledge and belief, the above information is true and complete. I understand that no insurance will be effective until this form is approved and the Policy is issued while the Insured is living. I authorize NGL to share my nonpublic personal information with any Funeral Provider with whom I have a Prefunded Funeral Agreement. If I am the Owner for insurance on the life of the Proposed Insured, I certify that I have an insurable interest in his or her life. If Monthly EFT is selected, the Insured and/or Owner authorize the withdrawal of all premiums due from the account provided. I acknowledge that I have read all information on the last page of this form.
8. SIGNATURES AND POLICY OWNER'S STATEMENT
Signature of Proposed Insured X Signature of
Policy OwnerCity & State Date
10. PRODUCER'S STATEMENT AND SIGNATUREAGENT'S STATEMENT: The Insured's signature personally witnessed by an agent for the company. I certify that any information recorded by me on this form is true and accurate to the best of my knowledge. Only insurer approved sales materials were used in conjunction with this sale, copies of which were left with the applicant.
Appointment Code
Signature of Producer
Printed Name of Producer
Producer Number
WAS WAS NOT
Zip
2.
City
PROPOSED INSURED'S INFORMATION
HEALTH QUESTIONS (Addressed to proposed insured)
5.
Face and Payment Amount Information
Payment Date (1-28th)
Monthly EFT - Total First Payment and ongoing Monthly Payments (include voided check)
Payment Mode Single Pay EFT From Checking
Montly EFT - Total First Payment ONLY (include voided check/one-time withdrawal)
Multi Pay EFT From Checking
Complete Payment Authorization Form
Single Pay
Available Plans
3 Year Pay
5 Year Pay
10 Year Pay
20 Year Pay
Annuity Other Payment Options
6. DIRECTIONS FOR PAYMENT OF PROCEEDS (Do not complete until you have read the last page of this form for important information)Name of Funeral Provider
Zip Beneficiary (other than Funeral Firm)
Relationship
PLAN AND PAYMENT DETAILS
Face Amount Monthly Payment Amount Payment Today
Single Pay $ $
Multi Pay $ $ $
Total Face Amount $_____________________ Total First Payment $ ____________________
PRECOA - TheCompletePreneedCompany
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shelBy s. aDam
Contact Information
shelby s. adam
446 Wright ct.
birmingham, al 35205
205-937-3046
Pass: vivee5shi
DOB: June 7 (92 years old)
Visa: 4556 0003 7417 7343
Exp: 7/2011
SSN: XXX-XX-9323
Occu: lens Grinder
Beneficiary: Meredith Young (sister)
Blood: O+
Weight:164 lbs
Height: 5’ 9”
Health: Healthy
In termediate
backGrounDShelby is 97 years old and lives in her small apartment in
Birmingham, Alabama.
Her best friend Maggie passed away 6 months ago and it has left
her thinking about her own funeral and how she would want her life
celebrated.
After many years of seeing the funeral home survey, she finally decided
to fill one out. Deep down she wants to have a beautiful service with
friends and family. However, she doesn’t want her beautiful funeral to
be a hassle for her children and grandchildren.
concernShe is contemplating doing two days of viewings, with a
ceremony, and a graveside service. No matter what she
decides, she wants to discuss it first with her 6 children and
some of her older grandchildren.
Funeral PreFerencesShelby would like to pay for her $13,995 funeral all at once.
She’s willing to pay what it costs to make it a beautiful
experience for those in attendance.
PRECOA - TheCompletePreneedCompany
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3000PN-I-KY 06-11 WHITE COPY - Insurance Company YELLOW COPY - Funeral Firm/Producers PINK COPY - Family
APPLICATION FOR INSURANCE/ANNUITY National Guardian Life Insurance Company (NGL)
Phone 800.988.0826 - Fax 866.228.9927 Two East Gilman Street - PO Box 1191 - Madison WI 53701-1191
1. REQUIRED: Have you been diagnosed by a physician with a terminal illness or are you receiving hospice care?
2. Are you confined to a bed, hospitalized, scheduled for surgery requiring an overnight hospital stay, or receiving skilled nursing care; OR within the past two (2) years, have you had, been diagnosed with, or received treatment (including medication) by a medical professional for any of the following: stroke, organ transplant, cancer (other than skin), immune system disorder; OR within the past one (1) year, have you had, been diagnosed with, or received treatment (including medication) by a medical professional for any of the following: COPD (Chronic Obstructive Pulmonary Disease), emphysema, chronic heart disease, congestive heart failure, or cirrhosis of the liver, kidney/renal failure, kidney dialysis, Alzheimer's disease, ALS (Amyotrophic Lateral Sclerosis) or amputation due to disease? Multipay Plan: If NO on question 1 and YES or not answered to question 2, death benefit will be limited. If YES on question 1 or not answered, an Annuity is available.
4.
1.First Name MI Last Name Male
Female
Date of Birth Age SSN
POLICY OWNER'S INFORMATION (If other than proposed insured)First Name MI Last Name Relationship SSN
3. MAILING ADDRESS (For delivery of policy and billings)Address
Secondary Phone Number
State
Primary Phone Number
IRREVOCABLE ASSIGNMENT (Initial only if the Policy should be irrevocably assigned.)9.
I elect to assign this Policy subject to the terms of the Irrevocable Assignment of Policy on the last page of this form.
Owner Initials
Yes No
Yes No
REPLACEMENTYes NoYes NoYes NoYes No
7.APPLICANT REPLACEMENT - Do you have any existing insurance policies or annuity contracts? Will the insurance applied for replace or change any insurance or annuity now or recently in force? If "Yes", complete required replacement form(s). AGENT REPLACEMENT - Does the applicant have any existing insurance policies or annuity contracts? Will the insurance applied for replace or change any insurance or annuity now or recently in force?
To the best of my knowledge and belief, the above information is true and complete. I understand that no insurance will be effective until this form is approved and the Policy is issued while the Insured is living. I authorize NGL to share my nonpublic personal information with any Funeral Provider with whom I have a Prefunded Funeral Agreement. If I am the Owner for insurance on the life of the Proposed Insured, I certify that I have an insurable interest in his or her life. If Monthly EFT is selected, the Insured and/or Owner authorize the withdrawal of all premiums due from the account provided. I acknowledge that I have read all information on the last page of this form.
8. SIGNATURES AND POLICY OWNER'S STATEMENT
Signature of Proposed Insured X Signature of
Policy OwnerCity & State Date
10. PRODUCER'S STATEMENT AND SIGNATUREAGENT'S STATEMENT: The Insured's signature personally witnessed by an agent for the company. I certify that any information recorded by me on this form is true and accurate to the best of my knowledge. Only insurer approved sales materials were used in conjunction with this sale, copies of which were left with the applicant.
Appointment Code
Signature of Producer
Printed Name of Producer
Producer Number
WAS WAS NOT
Zip
2.
City
PROPOSED INSURED'S INFORMATION
HEALTH QUESTIONS (Addressed to proposed insured)
5.
Face and Payment Amount Information
Payment Date (1-28th)
Monthly EFT - Total First Payment and ongoing Monthly Payments (include voided check)
Payment Mode Single Pay EFT From Checking
Montly EFT - Total First Payment ONLY (include voided check/one-time withdrawal)
Multi Pay EFT From Checking
Complete Payment Authorization Form
Single Pay
Available Plans
3 Year Pay
5 Year Pay
10 Year Pay
20 Year Pay
Annuity Other Payment Options
6. DIRECTIONS FOR PAYMENT OF PROCEEDS (Do not complete until you have read the last page of this form for important information)Name of Funeral Provider
Zip Beneficiary (other than Funeral Firm)
Relationship
PLAN AND PAYMENT DETAILS
Face Amount Monthly Payment Amount Payment Today
Single Pay $ $
Multi Pay $ $ $
Total Face Amount $_____________________ Total First Payment $ ____________________
PRECOA - TheCompletePreneedCompany
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Connie j. BuCKley
Contact Information
connie J. buckley
1764 ten mile rd.
bedford, Ma 01730
781-689-7628
Pass: ah47734
DOB: May 30 (69 years old)
Visa: 5224 5632 1178 0362
Exp: 8/2016
SSN: XXX-XX-1754
Occu: Marketing analyst
Beneficiary: Hillary smith (daughter)
Blood: O+
Weight:120 lbs
Height: 5’ 5”
Health: Healthy
In termediate
backGrounDConnie is 69 years old and her hometown is in Bedford, MA.
Her younger sister just preplanned because she saw how seamless the
process was when her mother-in-law passed away the year before. She
recommended the Connie check it out.
Connie received a survey from the funeral home and decided to
send it in. Connie and her husband (veteran in WWII) have done well
financially but have always been frugal in their decisions. They are
retired and have raised a family of four children. They have 3 beautiful
grandchildren with two more on the way.
Lately, she has been thinking about her children and grandchildren.
And while her children all love each other very much she is concerned
about how well they will work together if she and her husband were to
pass away. She wants her funeral to bring her family together; not drive
them apart.
concernShe is interested in what her options are, but she is a
thinker. Connie would like some time to think things over,
do some research, and compare prices and products.
Funeral PreFerencesConnie would like to make a $1,500 down payment to
her $5,200 traditional funeral. She would like to pay the
remaining amount on a 5-year automatic withdrawal. She
would like payments to be withdrawn on the 20th of the
month.
PRECOA - TheCompletePreneedCompany
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3000PN-I-KY 06-11 WHITE COPY - Insurance Company YELLOW COPY - Funeral Firm/Producers PINK COPY - Family
APPLICATION FOR INSURANCE/ANNUITY National Guardian Life Insurance Company (NGL)
Phone 800.988.0826 - Fax 866.228.9927 Two East Gilman Street - PO Box 1191 - Madison WI 53701-1191
1. REQUIRED: Have you been diagnosed by a physician with a terminal illness or are you receiving hospice care?
2. Are you confined to a bed, hospitalized, scheduled for surgery requiring an overnight hospital stay, or receiving skilled nursing care; OR within the past two (2) years, have you had, been diagnosed with, or received treatment (including medication) by a medical professional for any of the following: stroke, organ transplant, cancer (other than skin), immune system disorder; OR within the past one (1) year, have you had, been diagnosed with, or received treatment (including medication) by a medical professional for any of the following: COPD (Chronic Obstructive Pulmonary Disease), emphysema, chronic heart disease, congestive heart failure, or cirrhosis of the liver, kidney/renal failure, kidney dialysis, Alzheimer's disease, ALS (Amyotrophic Lateral Sclerosis) or amputation due to disease? Multipay Plan: If NO on question 1 and YES or not answered to question 2, death benefit will be limited. If YES on question 1 or not answered, an Annuity is available.
4.
1.First Name MI Last Name Male
Female
Date of Birth Age SSN
POLICY OWNER'S INFORMATION (If other than proposed insured)First Name MI Last Name Relationship SSN
3. MAILING ADDRESS (For delivery of policy and billings)Address
Secondary Phone Number
State
Primary Phone Number
IRREVOCABLE ASSIGNMENT (Initial only if the Policy should be irrevocably assigned.)9.
I elect to assign this Policy subject to the terms of the Irrevocable Assignment of Policy on the last page of this form.
Owner Initials
Yes No
Yes No
REPLACEMENTYes NoYes NoYes NoYes No
7.APPLICANT REPLACEMENT - Do you have any existing insurance policies or annuity contracts? Will the insurance applied for replace or change any insurance or annuity now or recently in force? If "Yes", complete required replacement form(s). AGENT REPLACEMENT - Does the applicant have any existing insurance policies or annuity contracts? Will the insurance applied for replace or change any insurance or annuity now or recently in force?
To the best of my knowledge and belief, the above information is true and complete. I understand that no insurance will be effective until this form is approved and the Policy is issued while the Insured is living. I authorize NGL to share my nonpublic personal information with any Funeral Provider with whom I have a Prefunded Funeral Agreement. If I am the Owner for insurance on the life of the Proposed Insured, I certify that I have an insurable interest in his or her life. If Monthly EFT is selected, the Insured and/or Owner authorize the withdrawal of all premiums due from the account provided. I acknowledge that I have read all information on the last page of this form.
8. SIGNATURES AND POLICY OWNER'S STATEMENT
Signature of Proposed Insured X Signature of
Policy OwnerCity & State Date
10. PRODUCER'S STATEMENT AND SIGNATUREAGENT'S STATEMENT: The Insured's signature personally witnessed by an agent for the company. I certify that any information recorded by me on this form is true and accurate to the best of my knowledge. Only insurer approved sales materials were used in conjunction with this sale, copies of which were left with the applicant.
Appointment Code
Signature of Producer
Printed Name of Producer
Producer Number
WAS WAS NOT
Zip
2.
City
PROPOSED INSURED'S INFORMATION
HEALTH QUESTIONS (Addressed to proposed insured)
5.
Face and Payment Amount Information
Payment Date (1-28th)
Monthly EFT - Total First Payment and ongoing Monthly Payments (include voided check)
Payment Mode Single Pay EFT From Checking
Montly EFT - Total First Payment ONLY (include voided check/one-time withdrawal)
Multi Pay EFT From Checking
Complete Payment Authorization Form
Single Pay
Available Plans
3 Year Pay
5 Year Pay
10 Year Pay
20 Year Pay
Annuity Other Payment Options
6. DIRECTIONS FOR PAYMENT OF PROCEEDS (Do not complete until you have read the last page of this form for important information)Name of Funeral Provider
Zip Beneficiary (other than Funeral Firm)
Relationship
PLAN AND PAYMENT DETAILS
Face Amount Monthly Payment Amount Payment Today
Single Pay $ $
Multi Pay $ $ $
Total Face Amount $_____________________ Total First Payment $ ____________________
PRECOA - TheCompletePreneedCompany
16
Galen & sara Davis
Contact Information
Galen r. Davis
sara o. Davis
4264 aaron smith Dr.
Portland, or 97070
503-712-2341
Pass: galen8739
DOB: G: June 26 (54 years old)
s: sep. 13 (53 years old)
Visa: 4125 0054 4798 5482
Exp: 7/2015
SSN: G: XXX-XX-4568
s: XXX-XX-7587
Occu: G: Hospitality
s: social Work
Beneficiary: G/s: Mark Davis (son)
Blood: G: b+ s: o-
Weight: G: 184 lbs s: 137
lbs
Height: G: 6’ 1” s: 5’5”
Health: G: lung cancer
s: Healthy
advanced
backGrounDGalen and Sara have been married for over 20 years and
love living on the west coast.
Last year, Galen found out that he had lung cancer. Things have never
been the same. Sara had to find a part time job to pay the extra medical
bills. They have heard about preplanning but are very skeptical about
the benefits. A friend referred a counselor to them and practically
is forcing them to meet with you. They have already been taken
advantage of with medical fees.
concernGalen and Sara have two children and one grandchild. Sara
doesn’t even want to think about her funeral, let alone
Galen’s funeral, and the mere topic makes her upset. In
addition, they have already cashed in their life insurance to
cover medical expenses and only have a small reserve of
cash stored up.
Funeral PreFerencesThey would both like a basic cremation costing $2,500
each. They can afford to pay for one funeral in cash and the
other would need to be paid over a 20-year period. They
would prefer to be billed on a quarterly basis.
PRECOA - TheCompletePreneedCompany
17
3000PN-I-KY 06-11 WHITE COPY - Insurance Company YELLOW COPY - Funeral Firm/Producers PINK COPY - Family
APPLICATION FOR INSURANCE/ANNUITY National Guardian Life Insurance Company (NGL)
Phone 800.988.0826 - Fax 866.228.9927 Two East Gilman Street - PO Box 1191 - Madison WI 53701-1191
1. REQUIRED: Have you been diagnosed by a physician with a terminal illness or are you receiving hospice care?
2. Are you confined to a bed, hospitalized, scheduled for surgery requiring an overnight hospital stay, or receiving skilled nursing care; OR within the past two (2) years, have you had, been diagnosed with, or received treatment (including medication) by a medical professional for any of the following: stroke, organ transplant, cancer (other than skin), immune system disorder; OR within the past one (1) year, have you had, been diagnosed with, or received treatment (including medication) by a medical professional for any of the following: COPD (Chronic Obstructive Pulmonary Disease), emphysema, chronic heart disease, congestive heart failure, or cirrhosis of the liver, kidney/renal failure, kidney dialysis, Alzheimer's disease, ALS (Amyotrophic Lateral Sclerosis) or amputation due to disease? Multipay Plan: If NO on question 1 and YES or not answered to question 2, death benefit will be limited. If YES on question 1 or not answered, an Annuity is available.
4.
1.First Name MI Last Name Male
Female
Date of Birth Age SSN
POLICY OWNER'S INFORMATION (If other than proposed insured)First Name MI Last Name Relationship SSN
3. MAILING ADDRESS (For delivery of policy and billings)Address
Secondary Phone Number
State
Primary Phone Number
IRREVOCABLE ASSIGNMENT (Initial only if the Policy should be irrevocably assigned.)9.
I elect to assign this Policy subject to the terms of the Irrevocable Assignment of Policy on the last page of this form.
Owner Initials
Yes No
Yes No
REPLACEMENTYes NoYes NoYes NoYes No
7.APPLICANT REPLACEMENT - Do you have any existing insurance policies or annuity contracts? Will the insurance applied for replace or change any insurance or annuity now or recently in force? If "Yes", complete required replacement form(s). AGENT REPLACEMENT - Does the applicant have any existing insurance policies or annuity contracts? Will the insurance applied for replace or change any insurance or annuity now or recently in force?
To the best of my knowledge and belief, the above information is true and complete. I understand that no insurance will be effective until this form is approved and the Policy is issued while the Insured is living. I authorize NGL to share my nonpublic personal information with any Funeral Provider with whom I have a Prefunded Funeral Agreement. If I am the Owner for insurance on the life of the Proposed Insured, I certify that I have an insurable interest in his or her life. If Monthly EFT is selected, the Insured and/or Owner authorize the withdrawal of all premiums due from the account provided. I acknowledge that I have read all information on the last page of this form.
8. SIGNATURES AND POLICY OWNER'S STATEMENT
Signature of Proposed Insured X Signature of
Policy OwnerCity & State Date
10. PRODUCER'S STATEMENT AND SIGNATUREAGENT'S STATEMENT: The Insured's signature personally witnessed by an agent for the company. I certify that any information recorded by me on this form is true and accurate to the best of my knowledge. Only insurer approved sales materials were used in conjunction with this sale, copies of which were left with the applicant.
Appointment Code
Signature of Producer
Printed Name of Producer
Producer Number
WAS WAS NOT
Zip
2.
City
PROPOSED INSURED'S INFORMATION
HEALTH QUESTIONS (Addressed to proposed insured)
5.
Face and Payment Amount Information
Payment Date (1-28th)
Monthly EFT - Total First Payment and ongoing Monthly Payments (include voided check)
Payment Mode Single Pay EFT From Checking
Montly EFT - Total First Payment ONLY (include voided check/one-time withdrawal)
Multi Pay EFT From Checking
Complete Payment Authorization Form
Single Pay
Available Plans
3 Year Pay
5 Year Pay
10 Year Pay
20 Year Pay
Annuity Other Payment Options
6. DIRECTIONS FOR PAYMENT OF PROCEEDS (Do not complete until you have read the last page of this form for important information)Name of Funeral Provider
Zip Beneficiary (other than Funeral Firm)
Relationship
PLAN AND PAYMENT DETAILS
Face Amount Monthly Payment Amount Payment Today
Single Pay $ $
Multi Pay $ $ $
Total Face Amount $_____________________ Total First Payment $ ____________________
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18
GeorGe & WanDa raven
Contact Information
George M. raven
Wanda l. raven
2986 cooks Mine rd.
albuquerque, nM 87109
503-730-2928
Pass: eo3alVeeph
DOB: G: December 9 (73 years old)
W: June 14 (68 years old)
Visa: 5224 5632 1178 0362
Exp: 11/2016
SSN: G: XXX-XX-8254
W: XXX-XX-5486
Occu: G: educator
W: camp counselor
Beneficiary: Mel raven (Daughter)
Blood: G: o- W: a-
Weight: G: 210 lbs W: n/a
Height: G: 6’ 2” W: 5’7”
Health: see background Info
advanced
backGrounDGeorge and Wanda were married just three years ago in the
Grand Canyon. Each of their previous spouses had passed
away years earlier. A couple months ago, they went to
a funeral of their neighbor and saw the pain, sorrow and
turmoil. More importantly, they saw the contention and
arguing that came up within the family as decisions were
being made and costs were revealed.
They knew, right then and there, that they did not want their children
to deal with the financial pressures of a funeral. Especially, given the
nature of their separate families. Three weeks ago, they attended a
Peace of Mind Seminar at their church and checked off that they were
interested in learning more.
concernThey received a phone call and set up a time to meet. The
presentation seemed nice, but they were still very hesitant
to close. They are very interested in preplanning, but
George is nervous about the additional cost of paying for
his funeral over time and Wanda wants to talk with her
children before making a decision.
Funeral PreFerencesGeorge doesn’t want a service nor a viewing. He doesn’t
like the idea of being cremated but wants something
simple. George’s funeral will cost $3,900 and he would like
to pay for it over a 3-year period but is interested in the
early pay-off option. He would like to make payments on
his credit card.
Wanda, on the other hand, wants a traditional service with a viewing
and ceremony but isn’t sure if she can afford it. Wanda can only afford
$120 per month. She would like to setup EFT for the 25th of the month.
PRECOA - TheCompletePreneedCompany
19
GeorGe & WanDa raven
3000PN-I-KY 06-11 WHITE COPY - Insurance Company YELLOW COPY - Funeral Firm/Producers PINK COPY - Family
APPLICATION FOR INSURANCE/ANNUITY National Guardian Life Insurance Company (NGL)
Phone 800.988.0826 - Fax 866.228.9927 Two East Gilman Street - PO Box 1191 - Madison WI 53701-1191
1. REQUIRED: Have you been diagnosed by a physician with a terminal illness or are you receiving hospice care?
2. Are you confined to a bed, hospitalized, scheduled for surgery requiring an overnight hospital stay, or receiving skilled nursing care; OR within the past two (2) years, have you had, been diagnosed with, or received treatment (including medication) by a medical professional for any of the following: stroke, organ transplant, cancer (other than skin), immune system disorder; OR within the past one (1) year, have you had, been diagnosed with, or received treatment (including medication) by a medical professional for any of the following: COPD (Chronic Obstructive Pulmonary Disease), emphysema, chronic heart disease, congestive heart failure, or cirrhosis of the liver, kidney/renal failure, kidney dialysis, Alzheimer's disease, ALS (Amyotrophic Lateral Sclerosis) or amputation due to disease? Multipay Plan: If NO on question 1 and YES or not answered to question 2, death benefit will be limited. If YES on question 1 or not answered, an Annuity is available.
4.
1.First Name MI Last Name Male
Female
Date of Birth Age SSN
POLICY OWNER'S INFORMATION (If other than proposed insured)First Name MI Last Name Relationship SSN
3. MAILING ADDRESS (For delivery of policy and billings)Address
Secondary Phone Number
State
Primary Phone Number
IRREVOCABLE ASSIGNMENT (Initial only if the Policy should be irrevocably assigned.)9.
I elect to assign this Policy subject to the terms of the Irrevocable Assignment of Policy on the last page of this form.
Owner Initials
Yes No
Yes No
REPLACEMENTYes NoYes NoYes NoYes No
7.APPLICANT REPLACEMENT - Do you have any existing insurance policies or annuity contracts? Will the insurance applied for replace or change any insurance or annuity now or recently in force? If "Yes", complete required replacement form(s). AGENT REPLACEMENT - Does the applicant have any existing insurance policies or annuity contracts? Will the insurance applied for replace or change any insurance or annuity now or recently in force?
To the best of my knowledge and belief, the above information is true and complete. I understand that no insurance will be effective until this form is approved and the Policy is issued while the Insured is living. I authorize NGL to share my nonpublic personal information with any Funeral Provider with whom I have a Prefunded Funeral Agreement. If I am the Owner for insurance on the life of the Proposed Insured, I certify that I have an insurable interest in his or her life. If Monthly EFT is selected, the Insured and/or Owner authorize the withdrawal of all premiums due from the account provided. I acknowledge that I have read all information on the last page of this form.
8. SIGNATURES AND POLICY OWNER'S STATEMENT
Signature of Proposed Insured X Signature of
Policy OwnerCity & State Date
10. PRODUCER'S STATEMENT AND SIGNATUREAGENT'S STATEMENT: The Insured's signature personally witnessed by an agent for the company. I certify that any information recorded by me on this form is true and accurate to the best of my knowledge. Only insurer approved sales materials were used in conjunction with this sale, copies of which were left with the applicant.
Appointment Code
Signature of Producer
Printed Name of Producer
Producer Number
WAS WAS NOT
Zip
2.
City
PROPOSED INSURED'S INFORMATION
HEALTH QUESTIONS (Addressed to proposed insured)
5.
Face and Payment Amount Information
Payment Date (1-28th)
Monthly EFT - Total First Payment and ongoing Monthly Payments (include voided check)
Payment Mode Single Pay EFT From Checking
Montly EFT - Total First Payment ONLY (include voided check/one-time withdrawal)
Multi Pay EFT From Checking
Complete Payment Authorization Form
Single Pay
Available Plans
3 Year Pay
5 Year Pay
10 Year Pay
20 Year Pay
Annuity Other Payment Options
6. DIRECTIONS FOR PAYMENT OF PROCEEDS (Do not complete until you have read the last page of this form for important information)Name of Funeral Provider
Zip Beneficiary (other than Funeral Firm)
Relationship
PLAN AND PAYMENT DETAILS
Face Amount Monthly Payment Amount Payment Today
Single Pay $ $
Multi Pay $ $ $
Total Face Amount $_____________________ Total First Payment $ ____________________
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20
Early Payoff—90 Days Same as Cash
For the Early Payoff option, the family simply pays the original face amount less any payments made to date. The family
gets full credit for all payments made. This option is only available during the first 90 days after policy issuance.
EPO Example 1: If the original funeral amount is $10,000 and the family made $600 worth of payments, the payoff amount
would be $9,400. (10,000 – 600 = 9,400)
Early Payoff—Anytime Payoff
Families can use the Anytime Payoff option anytime, with any payment plan. Simply take the original face amount
divided by the original number of payments over the life of the plan, multiplied by the remaining number of payments.
EPO Example 2: If the original funeral amount is $10,000 and it’s a 10-year plan, (120 original payments) and the family
wants to pay if off after making the 10th payment (110 remaining payments), the payoff amount would be $9,166.33.
[(10,000/120) X 110 = $9166.33]
The best way to calculatate early payoff is to simply call: (800) 988-0826
EPO Policy
If excess dollars are sent in with a customer’s premium then the customer needs to indicate if they want that excess to go
towards paying off future premiums or to be held for early pay-off.
If they want to apply the excess dollars to advance premium dates there will be no billing until the premium is used.
If the excess dollars are held for early payoff then they will be suspended until the balance of the excess dollars is equal to
the EPO amount. There is no interest paid on suspended dollars.
NGL does not allow credit card payments for payoffs.
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21
Early Payoff—Exercises
EPO Exercise 1-Abigail Anderson: Age 65, $5,000 FA, 10 yr., EFT, $80 PA (premium amount), # payments: 3
Original Face Amount:
Amount Paid in:
Early Payoff Amount:
EPO Exercise 2-Ben Alexander: Age 78, $12,000 FA, 3 yr., EFT, $2,100 DP, ________ PA, # payments: 2
Original Face Amount:
Amount Paid in:
Early Payoff Amount:
EPO Exercise 3-Addison Brown: Age 57, $7,500 FA, 20 yr., EFT, ________ PA, # payments: 10
Original Face Amount:
Original Number of Payments:
Number of Remaining Payments:
Early Payoff Amount:
EPO Exercise 4-Ben Baker: Age 82, $11,000 FA, 3 yr., EFT, ________ PA, # payments: 25
Original Face Amount:
Original Number of Payments:
Number of Remaining Payments:
Early Payoff Amount:
EPO Exercise 5-Claire Bell: Age 72, $4,000 FA, 10 yr., EFT, $500 DP, ________ PA, # payments: 60
Original Face Amount:
Original Number of Payments:
Number of Remaining Payments:
Early Payoff Amount:
PRECOA - TheCompletePreneedCompany
Memorial Guide: Part B
Building Rapport The look, the feeling, the words
Family, occupation, recreation, message
Transistion questions
Intro/survey, most, some, you
Reason, hearing
Unprepared, overwhelmed, 75-125
Five minutes, hardest part
Road map
Most common
Urgent tasks & decisions (ease burden)
No doubts
Peace of mind
Recalled memories (freedom)
Financial aspect (financial protection)
My purpose
Scenario
Only decision
Part A
Short history lesson, veteran, contacts, special instructions
Typical order, in reality, viewing
What would Mom or Dad have wanted?
Ceremony, committal, afterward
Questions
Part A filling out each section on form
Total price to cover everything
Monthly amounts
We have life insurance
Part B, important
Pitch, power, pack, punch, pause
Is this what he/she really wanted? Transition to cost
Time magazine, start
Form (services, visitation, death cert, etc.)
Costs go up, for example, life expectancy
More options, remaining balance
Payment (single, 20, 3, 10, extra, 5)
We want to think it over
Story about Part B
We want to talk with our children
We can’t afford it
We are going to move
Conversation
P. Experience
Professional
Preparation
Chit Chat
Topic Warm-up
Most, Some, & You
Final Wishes Organizer
Common Reasons
Pain, Pleasure, Purpose
Explaining Part A
Funeral Components
Time Magazine Study
Memorial Guide: Part A
Cost EstimateClosing
Overcoming Objections
Bonus Points
Total Score /220
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PRESENTATION RUBRIC
PRECOA - TheCompletePreneedCompany
cost estIMate WorksHeet
Name __________________________
Age ______
Today’s Costs: _________________________
Future Cost estimate:
5 Years: __________________________
10 Years: _________________________
15 Years: _________________________
20 Years: _________________________
Life Exp: ___________ Years: ________
Payment options
Single Pay: _________________________
3 Year EFT: _________________________
5 Year EFT: _________________________
10 Year EFT: _________________________
20 Year EFT: ________________________
Single Pay: __________________________
3 Year EFT: _________________________
5 Year EFT: _________________________
10 Year EFT: _________________________
20 Year EFT: ________________________
total Payment (family)
Single Pay: __________________________
3 Year EFT: _________________________
5 Year EFT: _________________________
10 Year EFT: _________________________
20 Year EFT: ________________________
homework:
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
______________________________________________________________________________
5 Years: __________________________
10 Years: _________________________
15 Years: _________________________
20 Years: _________________________
Life Exp: ___________ Years: ________
Today’s Costs: _________________________
Name __________________________
Age ______