MYGA Application Questionnaire

Ready to purchase? Start here.

About 10 minutes. These are the details the insurer and Virginia's annuity rules require. We review your answers, prepare your application and contact you to go over it before you e-sign. Prefer to talk first? Call or text (571) 368-6178.

Please do not enter Social Security numbers or account numbers here. We collect those securely when we prepare your application.

Your rate
Owner
Ownership

The annuitant is the person whose life the contract is based on. Usually the same as the owner.

Account type and funding
Beneficiaries

Primary shares must add up to 100%. Contingent beneficiaries receive the money only if no primary beneficiary survives.

Financial picture

Cash and investments you could reach within a few days, not counting this purchase.

Goals and needs
Before you submit
How would you prefer we reach you?

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