Request for Inforce Policy Illustration / Letter of Authorization <Date> Attention: <Insurance Carrier Name> Policyholder Service Department <Insurance carrier address> RE: Policies Numbers <insert policy numbers here> To whom it may concern: I do hereby appoint <name and state license number of life insurance agent> as authorized representative to receive information from your company. Please furnish <agent name> with all policy information requested in connection with my insurance policies issued through your company. Policy Status For the policies referenced above, please a policy status including current and guarantee values. Please include cost basis of policy. If applicable, please include loan values and rates, rider information and verify what your records show as; policy owner, beneficiaries, collateral assignments, billing information. Inforce Illustrations For each policy number, please forward inforce illustrations for checked items as follows: As is No further premiums Premium search to maturity based on minimum level premium to endow at current assumptions Please provide other inforce policy illustrations as follows: Please send requested information to: <name of licensed agent> <fax #, email address, mailing address> A copy of this request shall be as a valid as the original. Sincerely, ________________________________________________ Signature of Policyowner or Trustee ________________________________________________ Print Name of Policyowner or Trustee
Request for Inforce Policy Illustration / Letter of Authorization <Date> Attention: <Insurance Carrier Name> Policyholder Service Department <Insurance carrier address> RE: Policies Numbers <insert policy numbers here> To whom it may concern: I do hereby appoint <name and state license number of life insurance agent> as authorized representative to receive information from your company. Please furnish <agent name> with all policy information requested in connection with my insurance policies issued through your company. Policy Status For the policies referenced above, please a policy status including current and guarantee values. Please include cost basis of policy. If applicable, please include loan values and rates, rider information and verify what your records show as; policy owner, beneficiaries, collateral assignments, billing information. Inforce Illustrations For each policy number, please forward inforce illustrations for checked items as follows: As is No further premiums Premium search to maturity based on minimum level premium to endow at current assumptions Please provide other inforce policy illustrations as follows: Please send requested information to: <name of licensed agent> <fax #, email address, mailing address> A copy of this request shall be as a valid as the original. Sincerely, ________________________________________________ Signature of Policyowner or Trustee ________________________________________________ Print Name of Policyowner or Trustee
Request-for-Inforce-Policy-Illustration.docx