Agent Forms - 1891 Financial Life

Life Insurance and Annuity Applications are at the bottom of the webpage.

IMPORTANT: Click here for marketing in the state of CALIFORNIA and OREGON.
Other states please use the marketing flyers below:

Promotions

Product Flyers

WHOLE LIFE INSURANCE

TERM LIFE INSURANCE

Juvenile Term Insurance
Term Life Insurance
Key Person Life Insurance
Rate Sample:
- Affordable Protection – Whole Life and Term

RIDERS

Living Benefits Rider automatically included!
Accidental Death Benefit (ADB) Rider
Guaranteed Issue Option (GIO) Rider
Level Term Insurance (LTI) Rider
Waiver of Premium (WP) Rider
Charitable Rider

ANNUITIES

Agent Tools

Giving Back

Forms

Forms may be sent in by MAIL – 1891 Financial Life, 200 N. Martingale Rd., Ste. 405, Schaumburg, IL 60173

Recommender Award
Agent of Record Change Form
Transfer of Funds
Change of Beneficiary
Change of Owner
Lost Certificate (Policy) Statement
Annuity Contribution
Payments by Credit Card, Debit Card, or Electronic Funds Transfer (EFT)
EFT from may also be sent in by: FAX – 847-342-4556 or EMAIL – info@1891FinancialLife.com

Underwriting Guides

Life Insurance Applications

Your Questionnaires are below the life application list.

Life Application Questionnaires

Questionnaire Keys, these charts show when to use a questionnaire: CA, ND/SD, OR, all other states

Alcohol Questionnaire: CA, CO / IL / IN / IA / KS / MI / MN / MO / MT / NE / OH / WA / WI, OR, ND / SD
Aviation Questionnaire: CA, CO / IL / IN / IA / KS / MI / MN / MO / MT / NE / OH / WA / WI, OR, ND / SD
Criminal History Questionnaire: CA, CO / IL / IN / IA / KS / MI / MN / MO / MT / NE / OH / WA / WI, OR, ND / SD
Diabetes Questionnaire: CA, CO / IL / IN / IA / KS / MI / MN / MO / MT / NE / OH / WA / WI, OR, ND / SD
Driving History Questionnaire: CA, CO / IL / IN / IA / KS / MI / MN / MO / MT / NE / OH / WA / WI, OR, ND / SD
Drug Use Questionnaire: CA, CO / IL / IN / IA / KS / MI / MN / MO / MT / NE / OH / WA / WI, OR, ND / SD
Foreign Travel Questionnaire: CA, CO / IL / IN / IA / KS / MI / MN / MO / MT / NE / OH / WA / WI, OR, ND / SD
Hypertension Questionnaire: CA, CO / IL / IN / IA / KS / MI / MN / MO / MT / NE / OH / WA / WI, OR, ND / SD
Marijuana Questionnaire: CA, CO / IL / IN / IA / KS / MI / MN / MO / MT / NE / OH / WA / WI, OR, ND / SD
Mental Questionnaire: CA, CO / IL / IN / IA / KS / MI / MN / MO / MT / NE / OH / WA / WI, OR, ND / SD
Military Questionnaire: CA, CO / IL / IN / IA / KS / MI / MN / MO / MT / NE / OH / WA / WI, OR, ND / SD
Respiratory Questionnaire: CA, CO / IL / IN / IA / KS / MI / MN / MO / MT / NE / OH / WA / WI, OR, ND / SD
Seizure Questionnaire: CA, CO / IL / IN / IA / KS / MI / MN / MO / MT / NE / OH / WA / WI, OR, ND / SD
Sleep Apnea Questionnaire: CA, CO / IL / IN / IA / KS / MI / MN / MO / MT / NE / OH / WA / WI, OR, ND / SD
Sport, Amusement, Avocation Questionnaire: CA, CO / IL / IN / IA / KS / MI / MN / MO / MT / NE / OH / WA / WI, OR, ND / SD

Simplified Issue – Life Insurance Applications

Annuity Applications

Annuity Compensation Disclosure – Pre application form for Qualified Annuity plans, click here for CA or OR