ltc app kit request copyltc & di application kit request advisor: broker dealer: email: phone: if...

1. Carrier: Are you appointed with the carrier? Yes No Don’t Know 2. Product: 3. State: Same As Resident State? Yes No Genworth Lincoln MoneyGuard Assurity John Hancock Genworth Total Living Care MetLife Mutual of Omaha One America Asset Care Mutual of Omaha Transamerica Qualified Money Principle Standard 5. Product: 6. Replacement? Yes No 7. 1035 Money? Yes No 8. Is the coverage or application related to a business? It has been our experience that to process your business as fast as possible requires your help as well. To start you will need to have an accurate application kit with the required paperwork. We will aggressively process your business. The diligence you put into the application process, will have a direct effect on the time carriers take to process your business. LTC & DI Application Kit Request Advisor: Broker Dealer: Email: Phone: If you have any questions please contact either your Relationship Manager or Case Management We thank you for giving CORE Group the opportunity to serve you and your clients. The Application kit will be emailed to you within 24 hours of your request. CORE GROUP CASE MANAGEMENT Please return to CORE via email or fax: [email protected] or [email protected] Phone: 866-482-6002 Fax: 260-482-6082 3948 New Vision Drive Suite E Fort Wayne, IN 46845 We strongly recommend the use of a cover letter. Please make sure you are up to date on your LTC Continuing Education before an application is taken. If your CE is not current, a newly dated signed application will be required which will delay the process! If you have questions, please contact our licensing department at 800-991-6695 or [email protected]. Traditional LTC Asset Based LTC Disability

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1. Carrier:

Are you appointed with the carrier? Yes No Don’t Know

2. Product:

3. State: Same As Resident State? Yes No

Genworth Lincoln MoneyGuard Assurity

John Hancock Genworth Total Living Care MetLife

Mutual of Omaha One America Asset Care Mutual of Omaha

Transamerica Qualified Money Principle

Standard

5. Product:

6. Replacement? Yes No 7. 1035 Money? Yes No

8. Is the coverage or application related to a business?

It has been our experience that to process your business as fast as possible requires your help aswell. To start you will need to have an accurate application kit with the required paperwork. Wewill aggressively process your business. The diligence you put into the application process, willhave a direct effect on the time carriers take to process your business.

LTC & DI Application Kit Request

Advisor: Broker Dealer:Email: Phone:

If you have any questions please contact either your Relationship Manager or Case ManagementWe thank you for giving CORE Group the opportunity to serve you and your clients.

The Application kit will be emailed to you within 24 hours of your request.

CORE GROUP CASE MANAGEMENTPlease return to CORE via email or fax:

[email protected] or [email protected]: 866-482-6002 Fax: 260-482-6082

3948 New Vision Drive Suite EFort Wayne, IN 46845

We strongly recommend the use of a cover letter.

Please make sure you are up to date on your LTC Continuing Education before an application is taken. If your CE is not current, a newly dated signed application will be required which will delay the process! If you have questions,

please contact our licensing department at 800-991-6695 or [email protected].

Traditional LTC Asset Based LTC Disability

Advisor: Broker Dealer: Email: Phone: 1 Carrier: Are you appointed with the carrier: Off2 Product: 3 State: Same As Resident State: OffCheck Box1: OffCheck Box10: OffCheck Box2: OffCheck Box7: OffCheck Box11: OffCheck Box3: OffCheck Box8: OffCheck Box12: OffCheck Box4: OffCheck Box9: OffCheck Box13: OffCheck Box14: Off5 Product: 6 Replacement: Off7 1035 Money: Off8 Is the coverage or application related to a business: Button400: Button200: Button300: