Permanent Life Insurance Quote Request

Important!  If you are unsure what type of insurance you need or what is best for your client, contact The Ark Group at 866.725.0777 to discuss options.
Agent Information:

Agent name:

Phone number:


Client Information (basic):

Client name (important):

Client date of birth or age:

Client gender:

Client resident state:

Client Information (health history):

Client's build? 

Has your client used tobacco products in the last 12 months?

- If yes, how often has your client used the tobacco product?

- If yes, date last used?

What underwriting class do you want quoted?

List any health conditions, medications, dosages, and/or hospitalizations during the past 10 years:

Client Information: (current coverage)

Does your client currently have Life Insurance?

If yes, do they own Term or Permanent?

If Term, what are the coverage details?

- Carrier name?

- Original Term length?

- How many years left?

- Any riders?

- Premium?

If Permanent, what are the coverage details?

- Carrier name?

- Type of Insurance? 

- Any riders?

- Premium?

- Cash surrender value?

- Trust owned?

- Years owned policy?

Illustration Design:

Client's objective/intention for this policy?

What product do you need a quote for?  

What do you want us to solve for?

- If premium solve, desired face amount?

- If face amount solve, desired premium budgeted?

Do you want this policy to be paid up at a certain age?

- If so, what age?

If an Index UL is being requested: (With these quotes we generally solve for a lower face amount to maximize cash value)

- What interest rate do you want quoted? (pick one)

NOTE: If you are new to cash value Life Insurance & unsure of how to help your client determine what is best for their situation, here are a few questions to get you started:

What is your client's annual salary?

What basic premium funding option would you like us to use?

Would you like a Term, Disability Income or Critical Insurance quote as well for your client?  

- If so, what would you like to see quoted:

You're almost done!  Once you have answered the required questions above, click the "Submit Form" button to send us your request.  We will email your quote shortly!

Yes - Cigarette or Pipe
Yes - Chewing Tobacco
Yes - Cigar
If unsure, is your client overweight?
Preferred Plus (no meds, no family history, perfect ht/wt etc...)
Preferred (good ht/wt, good family history, HBP or cholesterol controled by meds)
Standard Plus (not all companies have this category)
Standard (average person in America, average ht/wt, no major health issues etc...)
Preferred Tobacco (good ht/wt, good family history, HBP or cholesterol controled by meds)
Standard Tobacco (average person in America, average ht/wt, no major health issues etc...)
Table Rating (if known, list table rating below with health history)
Unsure (list ALL known conditions, dates, and medications with dosages below:)
ULGuaranteed ULIndex ULWhole LifeUnsure
Guaranteed Universal Life
Indexed Universal Life
Current Assumption UL
Whole Life
Cash ValueDeath BenefitBoth
Premium AmountFace AmountBoth
Default (based on historical look back)
2% of annual salary
4% of annual salary
6% of annual salary