Ask the Underwriter

Our in-house underwriter can speed policy issue, help with best plan selection, offer rating advice, and even help avoid a decline or unfavorable MIB report.

Producer:
Client Information:

Age or DOB:

Height & Weight:

Smoker: Cigarette

Smoker: Pipe

Smoker: Vape

Smoker: Marijuana

Smoker: Other

Type of Coverage:

Benefit Amount:

Current Medications:

Health Conditions/Treatment:

Hospitalizations or 
Treatment:

Potentially Impaired-Risk
Employment or Hobbies?

Any Additional Underwriting 
Concerns?

Previous Declines or Ratings?

Art Jetter & Company © 2018   For financial professional use only. Not for use with the general public.

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