| Forms |
| The Estate Saver Medicaid Friendly Single Premium Pure Endowment Life Insurance Policy with No Cash Value Life Insurance Application (PE-04,Ed 03/04) No other forms necessary for The Estate Builder |
| The Wealth Protector Medicaid Friendly Flexible Premium Deferred Annuity and Medicaid Friendly Single Premium Immediate Annuity Forms 1 - 4 are mandatory for all applicants age 65 and over: 1. Withholding Certificate for Pension or Annuity Payments (W-4P) 2. Agent Application Data Form (AADF 03/10) 3. Annuity Sales Disclosure (ASD06, 12/05) 4. Annuity Sale Suitability Disclosure (ASCD) Life Insurance Replacement Form (RN1, 04/00)) Election/Withholding For Payees of Non-Periodic Payments (NPF-ANN, 06/96) Election / Withholding For Payees of Periodic Payments (PP-ANN, 06/96) Transfer of Funds Authorization Form (ATTFT, 05/97) |
| The Capital Transfer Single Premium Whole Life Insurance Policy with Terminal Illness Rider & No Cash Value Life Application - Florida Life Application - All Other States Doctor's Form For Terminal Illness Rider |
Deferred Annuity Application Florida Virginia All Other States Notice Regarding Standards For Medi-Cal Eligibility Form: California All Other States Full Disclosure To Client |
| Needed For All Annuity Sales in all States Annuity Sale Suitability Disclosure (ASCD) |
| Disclaimer *Please be certain to obtain necessary legal, financial and/or professional help. We cannot be responsible for State Laws, Rules or Procedures which may have changed. Barry Rahm Insurance does not provide legal or tax advice. |
| Sign up to get all LTC Medicaid Updates. |
| LTC Asset Protection and Medicaid Eligibility for Singles and Marrieds. The Best Plan for Long-Term-Care and Nursing Homes |
| Please call or email for a free illustration and any questions you may have. Barry Rahm Barry Rahm Insurance 1074 Diamond Crest Court, Santa Barbara, CA 93110 Phone Toll Free 800-255-1932, Local 805-683-6311 Fax 805-683-6313, Cell 805-455-4611 Email to barryrahm@verizon.net Home Bulletins Products Forms Software Brochures |
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| Forms Page Barry Rahm Insurance Serving Agents for over 35 Years Email to barryrahm@verizon.net 800-255-1932 Asset Protection & Qualification for Medicaid Eligibility for Nursing Homes* Guaranteed-Issue Single Premium Life Be sure to check out The Bulletins *Before proceeding, please see disclaimer at bottom of page. |
Our Newest Product The New Era In Life Insurance Guaranteed Issue, Increasing Death Benefit Single Premium Life Insurance Policy Life Application No other forms necessary for The New Era In Life Insurance |