JLTexpress App Checklist Make sure your case is a good fit for our JLTexpress App process. Please contact Pat Baker if you have questions.

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1 JLTexpress App Checklist Make sure your case is a good fit for our JLTexpress App process. Please contact Pat Baker if you have questions. Pat Baker Pat@JLThomasCo.com Toll Free (800) Phone (216) Fax (216) Checklist Was this case quick quoted due to medical impairments? o If yes, this case is not a good fit and will not receive the offer. Does the client uses ? Is the owner and the proposed insured the same person? Is the proposed insured 18 years or older or under age 65? If you are unsure if the case is a good fit please review with Pat Baker or one of our Marketing Reps Chester Ave. Cleveland, OH sales@jlthomasco.com (800) t: (216) f: (216)

2 JLTexpress App How it Works 1. The broker completes the JLTexpress App and submits via or fax. At this point you are done the rest is followed up by the carrier and client. 2. Your client will conduct a phone interview and schedule their exam with the carrier. 3. The client s signature is obtained by either o Phone, or during the exam. 4. Once approved, you deliver the policy or if elected the policy can be e-delivered via . Carriers Available 1500 Chester Ave. Cleveland, OH sales@jlthomasco.com (800) t:(216) f:(216)

3 JLTexpress App Workflow Life Ticket AppAssist Voice Signature Express Order Ticket Agent Signs via Speed e-ticket Express App Agent Signs via Life Ticket Fast App Agent Signs TermAccel or LincExpress

4 Express APP for Life Insurance APPLICANT INFORMATION Date of Birth: Male Female Phone: SS#: Driver s License #: Address: City: State: ZIP Code: Years At Address: Country of Birth: State of Birth: Height : Weight: US Citizen: Employer: Occupation: History of Drug or Alcohol Abuse? Ever Used Tobacco? DUI in last 10 years? If Yes, Date last used and Type of Tobacco: More than 2 moving violations in last 12 months? Best Time to Contact Client: Morning Evening Afternoon Have any immediate family members been diagnosed or died before age 65 with Cancer/Heart Disease? PROPOSED POLICY INFORMATION Is the proposed insured a member of the armed forces? Past Member AIG Banner Lincoln MetLife Principal Protective Prudential United of Omaha SBLI Plan Name: Premium: Payment: Annual Semi-Annual Quarterly Monthly State of Sale: Any Pending Insurance? Face Amount: Temporary Insurance? Purpose of Insurance: Class Quoted: Save Age: Riders: Waiver of Premium Accidental Death Benefit Accelerated Benefit Rider Return of Premium Child Rider BENEFICIARY INFORMATION SSN or Tax ID: Relationship: D.O.B.: OWNERSHIP INFORMATION (IF DIFFERENT THAN PROPOSED INSURED) SSN or Tax ID: Relationship: D.O.B.: FINANCIAL INFORMATION Income: Assets: Liabilities: Net Worth: Bankruptcy: If yes, discharged? EXISTING COVERAGE Carrier Name Face Amount Replacement? Yr. Issued Has insurance been declined, postponed, and offered other than applied for in the last year? If yes, please explain:

5 PRODUCER INFORMATION First Name: Middle: Last: SSN: Phone: Did you see the client during the sale? Are you related to the proposed insured? Are you delivering the policy face to If Yes, How? face? Knowledge of proposed insured: Self Known well for years? Know Slightly Met Very Recently Other SECOND PRODUCER INFORMATION (IF APPLICABLE) COMMISSION % First Name: Phone: Last Name: COMPLETE ONLY IF APPLYNG TO BANNER/WILLIAM PENN Do you have a history of alcohol or substance (drug) abuse? Have you had any DUIs in the past 5 years? Have you had more than two moving motor vehicle violations in the past 3 years? Have you used any nicotine based products in the past 36 months? Has either parent or a sibling of yours had a history of cardiovascular disease before age of 60? COMPLETE ONLY IF APPLYING THROUGH PRINCIPAL ACCELERATED UNDERWRITING PROGRAM Are you currently applying or have you applied for life insurance within the last year? Have you taken an insurance exam within the last year? If previously underwritten by The Principal, coverage was approved Preferred or Super Preferred. *Disregard cancer of opposite sex except for colon cancer. Disregard cancer if pertains to only one family member, and insured has regular check-ups targeted at early diagnosis. Please completed form to ExpressAPP@JLThomasCo.com or fax to For assistance or questions call True False N/A Applicant is a U.S. citizen or permanent resident with no travel or hazardous locations. True False Stated blood pressure is less than 135/80. True False Total cholesterol is less than 240, and cholesterol HDL ratio is less than 4.5. True False If age 50 or greater, applicant has a primary care physician and evidence of routine physicals. True False N/A No parent of sibling death from cardiovascular disease, stroke or diabetes prior to age 60. True False No parent of sibling death from breast, colon, ovarian or prostate cancer prior to age 60.* True False No history of bankruptcy in the past five years. True False No history of DUI or reckless driving within past five years. True False No life, health or disability insurance has been rated, ridered, or declined. True False No prior informal requests to The Principal within the last 24 months True False No labs have been ordered or completed within the last 12 months for life or disability insurance. True False Does the proposed insured have disability insurance?