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FIA INFO FORM

FIA Information Form

Product Information

Is this a qualified transaction?
Yes
No
Is there an income rider?
Financial Objective
How long do you plan to keep this annuity?

Agent Information

Is there a Split Agent?

LICENSED IN CLIENT STATE?

Is the writing agent licensed in the client state?

STATE SUITABILITY TRAINING

Has the writing agent complete state suitability in this state?

PRODUCT SPECIFIC TRAINING

Writing Agent: Have you completed required product-specific training?

Client Information

Date of Birth
Month
Day
Year
Are you a U.S. Citizen?
Is there a joint owner?

Contact Us

4248 Town Center Blvd.

Ste. 6

Orlando, FL 32827

Tel: 321-305-7669

Email: dominionlsd@gmail.com

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Thank You

© 2024 Dominion Consulting Agency. All rights reserved.

Neither World Financial Group Insurance Agency, LLC nor its agents may provide tax or legal advice.  Anyone to whom this material is promoted, marketed, or recommended should consult with and rely on their own independent tax and legal professional regarding their particular situation and the concepts presented herein.

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Many people have experience various levels of success with World Financial Group Insurance Agency, LLC. However, each individual’s experiences may vary. This statement is not intended to nor does it represent that any individual results are representative of what all participants achieve when following the World Financial Group system.

 

Dominion Consulting is an organization that is comprised of individuals associated with World Financial Group Insurance Agency, LLC and World Financial Group, Inc., but it is not an affiliated company of World Financial Group, Inc., WFGIA, World Financial Insurance Agency, LLC., World Financial Group Insurance Agency of Hawaii, Inc., World Financial Group Insurance Agency of Massachusetts, Inc. nor WFG Insurance Agency of Puerto Rico, Inc. (collectively referred to as “WFG”). These agents offer insurance products through World Financial Group Insurance Agency, LLC, World Financial Group Insurance Agency of Hawaii, Inc., World Financial Group Insurance Agency of Massachusetts, Inc., World Financial Insurance Agency, LLC. and/or WFG Insurance Agency of Puerto Rico, Inc. – collectively WFGIA.

This material is intended for education and training purposes only and is not intended to be , nor should it be construed as, an offer or solicitation for the purchase of sale of any specific product, financial services, or other non-specified item.

WFG Headquarters: 11315 Johns Creek Parkway, Suite 100, Johns Creek, GA 30097-1517. Phone: 770.453.9300

Dominion Leadership Development Headquarters: 2954 Mallory Cir. Ste. 210 Celebration, FL 34747. Phone: 321-305-7669

Neither World Financial Group Insurance Agency, LLC nor its agents may provide tax or legal advice.  Anyone to whom this material is promoted, marketed, or recommended should consult with and rely on their own independent tax and legal professional regarding their particular situation and the concepts presented herein.

 

Insurance Products and Services available only to the residents of:

Alabama (AL), Arizona (AZ), California (CA), Florida (FL), Georgia (GA), Hawaii (HI), Kentucky (KY),  Louisiana (LA), Massachusetts (MA), Maryland (MD), Mississippi (MS), Montana (MT),  New Mexico (NM), North Carolina (NC), Oregon (OR), Pennsylvania (PA), South Carolina (SC), Utah (UT), Virginia (VA),  Washington (WA), Wisconsin (WI), West Virginia (WV).

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Our platform offers the power of choice.

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Tax and Legal Disclosure Neither World Financial Group nor its agents may provide tax or legal advice. Anyone to whom this material is promoted, marketed, or recommended should consult with and rely on their own independent tax and legal professional regarding their particular situation and the concepts presented herein.

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SUCCESS / RESULTS FOOTNOTE:
Many people have experience various levels of success with World Financial Group. However, each individual’s experiences may vary. This statement is not intended to nor does it represent that any individual results are representative of what all participants achieve when following the World Financial Group system.

132089                                                                                          WFG-10.19

 

11 Providers listed maintains selling agreement (s) with World Financial Group Insurance Agency, LLC. World Financial Group Insurance Agency, LLC and its subsidiaries.

 

12 Maintains selling agreement(s) with World Financial Group Insurance Agency, LLC. World Financial Group Insurance Agency, LLC and Transamerica Life Insurance Company are affiliated companies.

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13 The city and state locations of these companies are: Transamerica Life Insurance Company, Cedar Rapids, Iowa; Pacific Life Insurance Company, Newport Beach, California; Nationwide Life Insurance Company, Columbus, Ohio; Everest Funeral Package, LLC, Houston, Texas; AMS Financial Solutions, Baton Rouge, Louisiana; Crump, Harrisburg, Pennsylvania; Athene Annuity and Life Company, West Des Moines, Iowa

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14 The World Financial Group Insurance Agency, LLC Financial Needs Analysis, developed by WFGIA, is based on the accuracy and completeness of the data provided by the client. The analysis uses sources that are believed to be reliable and accurate, although they are not guaranteed. Discuss any legal, tax or financial matter with the appropriate professional. Neither the information presented nor any opinion expressed constitutes solicitation for the purchase or sale of any specific product or financial service.

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