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Confidential

Confidential. Dear Customer Service Unit:

hayden-sellers
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Confidential

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  1. Confidential Dear Customer Service Unit: I am in the process of doing my annual Insurance Policy Review. Please provide me with in-force illustration on Policy Number: # 00000000000 that assumes current interest rates and current expenses in the future. Also, please assume current premium payments for the life of the contract as well as the original policy design if a “limited pay” scenario was sold. Additionally please provide me with the following information: Brian K. Adams & Associates, Inc. • 244 W. Water Street, Suite 200 • Elmira, New York 14901 Phone (607) 732–3050 • Fax (607) 732–3904 Please email the requested information to my representative Mr./Mrs/MsFA Name at First.Last@XYZ.com or FAX (516) XXX-XXXX. Your immediate response is greatly appreciated. X Owner

  2. Policy Review Data Sheet Date: Financial Institution: Financial Advisor: Phone: Fax: E-mail:Requested Return Date: Brian K. Adams & Associates, Inc. • 244 W. Water Street, Suite 200 • Elmira, New York 14901 Phone (607) 732–3050 • Fax (607) 732–3904

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