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BANKERS FULL NAME
CLIENTS FULL NAME
Clients Phone Number
Product Pitched:
MTG Protection
Payment Protection
Payments Quoted:
Policy Delivery Method:
Electronic
Mail
Clients DOB:
Clients Beneficiary:
Beneficiary DOB:
Does the Client Smoke Tobacco?
Yes
No
Does the client have diabetes?
Yes
No
Has the client ever been diagnosed with cancer?
Yes
No
Does the Client Have Health Issues?
Does the Client Use Any Medications?
Primary Care/Doctor Office Name:
Is the Client a US Citizen?
Does the Client have a Valid ID:
Yes
No
Has the Client Been Convicted of a Crime?
Monthly Household Expense Total:
Remaining MTG Balance:
MTG Payment:
Client Email:
Clients Beneficiary #2 (If needed):
Beneficiary DOB #2 (If needed):
Property Address:
Lock Script
Must Read Verbatim
This portion of the call will be recorded for quality and compliance purposes.
We are going to set you up with a _______ Policy
Your Estimated Monthly Payment is:
The Funds are Coming From:
The Name of the financial institution:
The Routing Number (Only if funds are coming from checking/savings)
The Account Number (Only if funds are coming from checking/savings)
Reason for getting the policy is to:
Based on everything I just reviewed with you, do you agree with the terms and conditions of this transaction?
Select one...
Yes
No
Thank you! Your submission has been received!
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