Salary Deferral Plans (Total Income Plans)

Producer Information Contributions

Name: Executive Contributions (Deferrals)

Company: Deferral Type:

Address: □% of Total Compensation

City: Number of Years

State: Zip Code: □Schedule:

Phone: Fax: □Specified Amount: $

Email: Number of Years

Corporate Insurance Funding:

Corporation Information □Before -Tax
Name of Company:
□After-Tax
State of Incorporation:
Corporate Contributions:
Corporate Tax Bracket:
□% of Executive Deferral: %
Plan Year: Number of Years:

□Schedule:
Benefits
Pre-Retirement Survivorship Benefits: □Specified Amount: $

□No Additional Benefit Number of Years

□As % of Total Compensation

Cost Recovery
□Specified Benefit:
Age at Death:
□Solve
□Life Expectancy:
□Specified Benefit
□Specified Age:
Benefit Years:
Quality Option:
Retirement Benefits:
□Out of Pocket
□Executive Rate of Return
□Borrow
Specified: %
□Withdraw
Solve:
□Withdraw to Basis and then Borrow
Benefit Years:
□Borrow
Cost Recovery (continued) Details of Program
Loan Interest Option: Individual Life Insurance:

□Pay Loan □Universal Life □Whole Life

□Accumulation UL □Level Premium
□Borrow Gross Interest
□Protection UL-G □Modified Premium(NJ only)
□Borrow After-tax Interest
□Performance UL Core
Recovery Option
□Performance UL
□Full Cost
□Variable
□Partial Cost
□Performance VUL
□Net Insurance Outlay □Accumulation VUL
□Net After-Tax Insurance Outlay □Protection VUL
□Premiums

□Retirement Benefits Survivorship Life Insurance

□Universal Life
□After-Tax Retirement Benefits
□Survivorship UL-G
□Loss Tax deduction on Deferrals
□whole Life (Traditional)
□Split Dollar Bonuses □Level Premium Estate Protection
□Including Cost of Money □Variable
□None □Survivorship VUL □Performance SVUL
Recovery Age: Death Benefit Options
□Specified Age: □Level

□Life Expectancy □Increasing

□Schedule
Investment Rate

□Cost of Money:
Comments
Accounting Method:

□APB 12After-Tax

Mortality Table:
□80 CSO Blended

□GAM 71

□Up 84

□Tax Facts
 Participant Information
1. Name Age/DOB Sex Smoking Salary Incentive Bonus Spouse Spouse
Status Compensation Amount Age U/W

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