Financial Suitability Questionnaire

Financial Suitability Questionnaire

Owner Information


Financial Information


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YesNo
Does your income cover all your living expenses including medical?
Do you expect changes to your living expenses?
Do you anticipate changes in your out-of-pocket medical expenses?
Is your income sufficient to cover future changes in your living and/or out-of-pocket medical expenses during the surrender charge period?
Do you have an emergency fund for unexpected expenses?

Acknowledgements and Signatures

I understand that should I decline to provide the requested information or should I provide inaccurate information, I am limiting the protection afforded me by the Florida Statutes regarding the suitability of this purchase.


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