Financial Suitability Questionnaire

Financial Suitability Questionnaire

Owner Information

Financial Information

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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