Topsider FIA Illustration Page

Topsider FIA

Need a Custom Illustration?

Please complete the form below and one of our committed sales representatives will provide you with your customized illustration and additional product information.

1. Owner Information

Client First Name(Required)

Client Last Name(Required)

Client Birthdate(Required)

Client State of Issuance(Required)

2. Agent Information

Agent First Name(Required)

Agent Last Name(Required)

Agent Email Address(Required)

Agent NPN

Affiliated Broker Dealer (If none, type N/A.)(Required)

3. Illustration Details

Surrender Period(Required)

Tax Qualification(Required)

Premium Amount ($)(Required)

Gain Control Percentage (Minimum Percentage = 50%)

4. Withdrawals (Optional)

Mode

Starting in Year

% of Contract Value

5. Premium Allocation

Strategy allocations are to be represented in WHOLE NUMBERS only.

Strategy

Allocation

S&P 500 Daily Risk Control 10% Excess Return Annual Point-to-Point with Par Rate and Gain Control Option

allocation1

Please enter a number from 0 to 100.

S&P 500 Annual Point-to-Point w/ Cap Rate

allocation2

Please enter a number from 0 to 100.

Fixed Interest Strategy

allocation3

Please enter a number from 0 to 100.

Allocation Total^*

^*Must be equal to 100%

totalallocation

Allocation Error: We won't be able to create this illustration unless your allocation is 100%. Please review your allocation option.

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Multi-Year Guaranteed Annuities

Harbourview

Sky Harbourview

Fixed Indexed Annuity

Harbourview

S&P 500 Crediting Strategy Options

Nasdaq-100 Crediting Strategy Option

Russell 2000 Crediting Strategy Option

Fixed Interest Strategy

Topsider FIA

Need a Custom Illustration?

Please complete the form below and one of our committed sales representatives will provide you with your customized illustration and additional product information.

1. Owner Information

2. Agent Information

3. Illustration Details

4. Withdrawals (Optional)

5. Premium Allocation

Strategy

Allocation

S&P 500 Daily Risk Control 10% Excess Return Annual Point-to-Point with Par Rate and Gain Control Option

S&P 500 Annual Point-to-Point w/ Cap Rate

Fixed Interest Strategy

Allocation Total^*

Multi-Year Guaranteed Annuities

Harbourview

Sky Harbourview

Fixed Indexed Annuity

Harbourview

S&P 500 Crediting Strategy Options

Nasdaq-100 Crediting Strategy Option

Russell 2000 Crediting Strategy Option

Fixed Interest Strategy

Topsider FIA

Need a Custom Illustration?

Please complete the form below and one of our committed sales representatives will provide you with your customized illustration and additional product information.

1. Owner Information

2. Agent Information

3. Illustration Details

4. Withdrawals (Optional)

5. Premium Allocation

Strategy

Allocation

S&P 500 Daily Risk Control 10% Excess Return Annual Point-to-Point with Par Rate and Gain Control Option

S&P 500 Annual Point-to-Point w/ Cap Rate

Fixed Interest Strategy

Allocation Total*

Allocation Total^*