Open Form Policy Review Form Name * First Name Last Name Email * Phone (###) ### #### What type of death has to occur in order for a claim to be paid? How much money will be paid to my beneficiary if I die? Do I have to die to file a claim? * YES NO Who picked your coverage? YOU Agent Was a Financial Needs Analysis done to determine coverage? YES NO Have I had any major life changes since my policy was written? * YES NO Is my heath or medications any different since my policy was written? * YES NO Can or will my premiums ever go up? * YES NO Can or will the face amount possibly ever change up or down? * YES NO Are there any riders in my policy? * YES NO Are there full living benefits included with my policy? * YES NO Is there any cash value in my policy? * (if YES,) YES NO (If YES to cash value) What happens to my policy if the cash value goes to zero and I'm still alive? Do you still have a mortgage? * YES NO Any other debts? * YES NO Are you making extra payments on anything? * YES NO Do you have the ability to do so? * YES NO Are there kids, spouse or grandkid's who need coverage? * YES NO Could any of your family, friends, or neighbors use living benefits? * YES NO Does my policy do what it needs to do? * YES NO Thank you! What’s In Your Policy?
