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Guaranteed Issue Contracting Request
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Guaranteed Issue Contracting Request
Great Western Guaranteed Issue Contracting Request
Have you presented this guaranteed issue whole life product/illustration to your client?
*
Yes
No
(Please present options to the client before proceeding with contracting. PLEASE only proceed with contracting if your client is ready to purchase.)
Can you confirm if your client is over the age of 40?
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Yes
No
You are unable to submit an e-application with either carrier due to the client being under the age of 40. Therefore, we cannot complete the contracting request for these two carriers.
Did you ask your client the 4 underwriting questions?
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Yes
No
(Please refer to the
4 underwriting questions
to ask your client to get them an additional 25% in their death benefit at no additional cost.)
Did your client agree to purchase the product and are they ready to submit an application to the carrier?
*
Yes
No
In order to proceed with contracting, your client has to agree to purchase the policy. If we get you contracted with the carrier and you do not submit an application in the first 30 days, the carrier will cancel your contract and we will have to go back through contracting again later. PLEASE only proceed with contracting if your client is ready to purchase.
Have you been contracted with this carrier under OCI?
*
Yes
No
Please follow the below E-App instructions for your carrier:
Great Western
Great Western E-Application Link
• Once the appointment is completed (you’ll receive an email from GWIC)
Click Here
.
• Click request new profile (this is an instant registration).
• E-App:
-Login.
-Select my enroller online.
-Note: Difference in plan options:
Assurance Plus: Option is you can answer no to the 4 underwriting questions.
Guaranteed Assurance: Option if you answer yes to one of the 4 underwriting questions.
Underwriting questions:
https://www.ociservices.com/wp-content/uploads/2021/10/Great-Western-Underwriting-Questions-10.18.21.pdf
• Electronic App Questions? Call (800) 733-5454 option 1, option 2.
Agent Name:
*
First
Last
Are you the agency owner?
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Yes
No
Agent Company:
*
Agent Email:
*
Agent Phone:
*
Client's Name:
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First
Last
Client's Date of Birth:
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MM slash DD slash YYYY
Coverage Amount:
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Select Face Amount
$10,000
$15,000
$20,000
$25,000
State:
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
Coverage Amount:
*
Select Face Amount
$10,000
$15,000
$20,000
$25,000
$30,000
$35,000
$40,000
PLEASE CONFIRM: Due to the internal cost and time needed for contracting, do you pinky promise that your client will move forward with purchasing the policy?
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Yes
No
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