EFS proposals are detailed. Please allow 24 to 48 hours.

Question Title

* 1. Please enter your contact information

Question Title

* 2. Through what IMO or brokerage firm will you likely place this case?

Question Title

* 3. Actual Name of Client (if known)

Question Title

* 4. Gender (Primary Insured)

Question Title

* 5. DOB or Age (Primary Insured)

Question Title

* 7. Policy Design (check all that apply)

Question Title

* 8. Solve amount (initial annual premium or death benefit objective or desired income beginning at a certain age)

Question Title

* 9. Qualified Plan Account Balances (if any)

Question Title

* 10. Household Net Worth

Question Title

* 11. Household Income

Question Title

* 12. State

Question Title

* 13. Other Residences

Question Title

* 14. Other Relevant Case Information

Question Title

* 15. I understand that EFS is a copyrighted program belonging exclusively to NextPoint Solutions, and I agree to respect all intellectual property rights, trade secrets, and other rights related to the program as they may be defined and amended from time to time.

Question Title

* 16. I understand that any information I receive from NextPoint Solutions, to the extent that it is not already in the public domain, is Confidential Information and I shall treat it as such. Accordingly, I agree to use such Confidential Information only to do business with NextPoint in accordance with NextPoint's normal rules and procedures, and not to do business on my own, or to share such Confidential Information with competitors of NextPoint.

Question Title

* 17. The Parties agree that the Confidential Information is disclosed “As-Is.”  Nothing contained in this Agreement or in any confidential information shall constitute any express or implied warranty of any kind, including without limitation, any warranty or merchantability, fitness for a particular purpose, or non-infringement.

Question Title

* 18. I further understand that neither NextPoint Solutions, nor any of its principals or employees, practices law or accounting, and accordingly does not offer legal or tax advice. Upon request, NextPoint may recommend experienced counsel. Clients are encouraged, nonetheless, to seek their own legal counsel, as well as professional tax advice.

Question Title

* 19. In consideration for the above, I agree to share the commissions on this case with NextPoint by placing the name and agent code of a designated NextPointrepresentative on the application for 25%.

Question Title

* 20. Print your name to act as your signature and accept the above Agreement

T