Annuity Case Design Complete this form to have FPG find your client the best Annuity Solution. Please enable JavaScript in your browser to complete this form.Agent Name *FirstLastTelephone *Email *Client Name *FirstLastGender *FemaleMaleDate of Birth *State *Married *YesNoSpouse's Name (if applicable)FirstLastSpouse's Date of Birth (if applicable)PremiumQualifiedNon-QualifiedAnnuity Type *Fixed AnnuityFixed Index AnnuitySingle Premium Immediate AnnuityAnnuity with LTC COBOptions (if applicable)Life OnlyLife with Period CertainLife with Cash RefundSurrender Period (select one ore more)N/A35678910Income Delay Period (if applicable)Period Certain (if applicable)5 Year6 Year7 Year8 Year9 Year10 Year11 Year12 Year13 Year14 Year15 Year16 Year17 Year18 Year19 Year20 YearNotesDo You Need Materials?Application FormsConsumer BrochuresSubmit