purpose of this guide - prudential...

NOT FOR CONSUMER USE. ©2017 The Prudential Insurance Company of America, Newark, NJ.NR-15A66401 Ed. 06/2017 Exp. 06/30/2019

Guide to Completing Life Insurance ApplicationsSERVICE

CREATED EXCLUSIVELY FOR FINANCIAL PROFESSIONALS

PURPOSE OF THIS GUIDE

This guide provides information that will help the user accurately complete the generic, individual long-form application packet. Unique applications exist for Juveniles age 0 to 17 as well as specific survivorship applications for use with SUL Protector.

This guide helps ensure once-and-done transaction processing. Easy-to-follow instructions and reminders are included about the primary portions of the forms listed below. The information in this guide is not state specific, so be sure to familiarize yourself with any state variations which can be found on www.pruxpress.com.

Replacements

Information on completing replacements is not included in this guide. If you have questions regarding replacements, please refer to the Replacement Highlighters located on Pruxpress.

To access the Replacement Highlighters on Pruxpress:

4Click on the “New Business” tab.

4Click on “Replacement Highlighters” (located in the drop-down box).

TABLE OF CONTENTS

Important Notes About This Guide . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2

Application Packet Checklist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Requirements for Non-Face-to-Face Sales . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3

Application for Life Insurance (ORD 96200) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-7

Authorization to Release Information (ORD 96200C) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Limited Insurance Agreement (ORD 96200A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8

Agent’s Report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9

Application Signature Requirements. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10

Obtaining and Submitting Additional Forms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11-12

SERVICE GUIDE TO COMPLETING LIFE INSURANCE APPLICATIONS

IMPORTANT NOTES ABOUT THIS GUIDE

Obtaining forms

Forms are accessible on-line via www.Pruxpress.com. To access forms on the website, click on the “Forms” tab and then “Launch Forms.” Be sure to select the appropriate state-specific version(s).

When completing forms

4Black ink is preferred as it photocopies the best.

4White-out is not allowed. To make corrections, draw a line through the mistake, write in the correct information, and have the appropriate party initial by the correct data.

Selecting the appropriate issuing company

At the top of many forms, you are asked to check the box for the appropriate company. Check:

4Pruco Life Insurance Company for all plans.

Definition of terms

4Producer: Sales representative, agent, broker, writing representative, etc.

4Proposed Insured: Person who is being considered for insurance on their life.

4Policyowner: Purchaser of the policy(s); account owner (often the same person{s} as the proposed insured).

Send completed forms to

Prudential Financial, Attn: Life New Business2101 Welsh Road/Suite DTYDresher, PA 19025

2


APPLICATION PACKET CHECKLIST

Before submitting this application:

Complete/include a cover letter summarizing the application and providing details that may help in the approval process, including:

4Amount (include information regarding pending applications with other companies and the ultimate total coverage with all companies, in force and pending).

4Purpose (financial justification) and coverage details (e.g., type of coverage, reason, etc.).

4Clearly labeled application(s) if submitting more than one application (e.g., is this an alternate, duplicate, etc.?).

4Clear definition(s) indicating if this is new or replacement* coverage.

4Specific details about policy change request(s) (e.g., is it clear what needs to be altered and/or is the increase amount clearly stated {if applicable}?).

4List all names on the application and provide complete addresses.

4Provide SSN or TIN A Tax Identification Number (TIN) may be either a Social Security Number (SSN) or an Employer Identification Number (EIN).

4Complete/include other applicable forms—See list of possible additional forms on pages 11 and 12.

4Ensure signatures were obtained.

4Include Special Instructions with clear explanations.

4Leave the Important Notice About Your Application for Insurance with the primary proposed insured.

4Attach the check for prepayment—Provided the proposed insured can certify the health attestations, and is less than or equal to 75 years old, a prepayment may be accepted on face amounts applied for up to and including $5,000,000, either as a single $5,000,000 application or as multiple applications totaling no more than $5,000,000 for both individuals on survivorship plans.

NOTE: The total death benefit payable under all Limited Insurance Agreements (LIAs) combined is the amount applied for, up to a maximum of $1,000,000 (per insured).

4Include underwriting requirements

• APS • ECG • Exam • Financial Information • Lab Work • Other

REQUIREMENTS FOR NON-FACE-TO-FACE SALES

4The collection of the application information must be conducted by the producer with both the proposed insured and the owner, if the owner is other than the proposed insured.

4The producer securely sends the application package to the insured/owner to be signed, along with any required forms and illustration requirements where applicable. NOTE: The Agent’s Report and Xpress Worksheet (as applicable) is NOT to be included in the application package. These items are to be completed by the producer.

4The insured/owner reviews and signs the application package, and sends it back to the producer.

4The producer reviews the application package to ensure it’s in good order, signs the application package, and then submits it to the Brokerage General Agency for submission to Prudential.

* Replacement coverage involves a transaction in which a new life insurance policy or a new annuity contract is to be purchased, and it is known or should be known to the proposing

producer that by reason of the transaction, an existing life insurance policy or annuity contract has been or is to be lapsed, forfeited, surrendered or partially surrendered, assigned to the replacing insurer, or otherwise terminated. See the Replacement Highlighters available on Pruxpress.com for additional information on understanding replacements.

3


Section of Form Did You Know? Instructions

Heading: PrudentialApplication for LifeInsurance

4Check applicable box for the correct issuing company (Pruco).

4Enter policy number (if available).

A: Proposed Insured

4Vague comments such as “consultant” as the occupation may prompt additional questions. Without complete and accurate information, application approval may be delayed or denied.

4Complete ALL information that is asked for.

4Check YES box if requesting to save age; otherwise, check NO.

4Residence address MUST be a street address; P.O. boxes are not permitted.

4If proposed insured is not a permanent, legal U.S. resident, ALL details regarding status must be provided.

4Occupation—Provide nature of the business and specific duties.

B: Plan of Insurance

4The plan name is available on the illustration (e.g., Term Essential 20, etc.).

4Check the plan name. If the specific plan requested is not listed, check the OTHER box and write the full plan name on the line.

4Check the applicable optional benefits and riders. If the specific benefit/rider requested is not listed, check the OTHER box and write name on the line.

4Where applicable, check the death benefit option type and the definition of life insurance used. If the specific plan is not listed, write requested selections in SPECIAL REQUESTS (Section H).

C: Premium

4For non-term plans, enter the billed premium amount.

4Send Notices: Check if the notices are to be sent to the policyowner or someone else’s attention. If other than the policyowner, identify the individual.

4Check if notices are to be sent to the policyowner’s residence or another location. If a location other than the policyowner’s residence is requested, identify the location.

D: Owner

4Only complete this section if the policyowner is other than the proposed insured.

4If a trust is the owner, provide the name of the trust, the trustee(s) and the date. Also include whether the trust is revocable or irrevocable.

4If the policyowner is an individual, be sure to include the full name, SSN or TIN, date of birth, and address of the policyowner.

4If more than one owner, include the additional owner’s information in SPECIAL REQUESTS (Section H).

E: Beneficiary Details4Enter complete information on all beneficiaries, including checking whether

the beneficiary is a primary or secondary beneficiary.

F: Insurance History

4Check YES or NO regarding whether the client has existing coverage.

4Check YES or NO if a replacement.

4When YES is selected for a replacement, also check YES or NO if a 1035 exchange is involved.

4Complete all requested information for each existing policy.

4Is the proposed insured attempting to reinstate or change a life or health policy? If YES, include the insurance company, the amount applied for, and the total amount of coverage to be placed.

4Is the proposed insured planning on transferring ownership of the policy to an investor or a life settlement company? If YES, provide full details.

APPLICATION FOR LIFE INSURANCE (ORD 96200)PART ONE: SECTIONS A–F

4



G: General Information

4Be sure to provide specific details about aviation, avocation, other applications, criminal offenses, driving violations, and travel.

IT IS CRITICAL TO FULLY AND ACCURATELY COMPLETE THIS SECTION.

4Aviation: If yes, complete the aviation questionnaire (ORD 96200 Aviation).

4Avocation/hobbies: If yes, complete the appropriate avocation form (ORD 96200 Diving, Mountain Climbing, Racing, General Avocation).

4Tobacco: Include all forms of tobacco and list the frequency of use and the dates last used.

4Driver’s license: Complete in full.

4Criminal offense: If yes, provide details.

4Residence or travel outside of the U.S.: Provide details such as dates of trips, the countries visited, the frequency of travel, the purpose, the duration of stay, etc.

4Include all details to YES responses for Questions 4 –6 on the lines in Question 7.

H: Special Requests

4Enter information on items such as:

– Explanation of the policy change.

– Request for additional policies.

– Beneficiary & owner information.

APPLICATION FOR LIFE INSURANCE (ORD 96200) (continued)

PART ONE: SECTIONS G–H


A: Physician Information

4You don’t need to complete all of Part Two if the client is having a full exam on Prudential exam forms. It is still helpful, however, to complete Section A of Part Two (In case the exam results are delayed, Prudential will at least have this information to know whether an APS is required).

4Complete the physician information in full.

B: Physical Measurements

4You don’t need to complete this section if a full Prudential exam has already been performed and you are submitting the results with the application.

4Enter the client’s height and weight.

4Enter the full details regarding any change in weight greater than 10 pounds.

APPLICATION FOR LIFE INSURANCE (ORD 96200)

PART TWO: SECTIONS A–B4Complete all of Part Two if you are using another company’s exam.

5



C: Family History

4Question #1 is frequently incomplete, which can cause a delay in the approval process.

4You are not required to complete this if a full Prudential exam has been completed. It is helpful, however, to still complete and submit the family history section even if the exam is complete.

IT IS CRITICAL TO FULLY AND ACCURATELY COMPLETE THIS SECTION.

4Provide the specific details for immediate family members (parents and siblings) only for death or diagnosis of listed conditions before age 70.

4Provide the current age or age at time of death only for parents.

D: Medical Information

4Complete for ALL NEW BUSINESS.

4Watch for state-specific variables. If a portion of a question is NOT applicable in a certain state, only that component of the question should not be asked or answered. The remainder of the question should be asked and answered and not left blank.

4Use the following page (sample page shown below) of this form/ application to provide the specific details for any questions that were answered YES.


PART TWO: SECTIONS C–D

6

FOR THE EDUCATION OF PRODUCERS/BROKERS. NOT FOR USE WITH THE PUBLIC.

Section of Form Did You Know Instructions

C: Family History 4 Question #1 isfrequently incompletewhich can cause adelay in the approvalprocess.

4 You are not requiredto complete this if afull Prudential examhas been completed.It is helpful, however,to still complete andsubmit the familyhistory section even ifthe exam is complete.

IT IS CRITICAL TO FULLY AND ACCURATELYCOMPLETE THIS SECTION!

4Provide specific details for immediate family members(parents & siblings) only for death or diagnosis of listedconditions before age 70.

4Provide current age or age at time of death only forparents.

D: Medical Information 4 Complete for ALL NEW BUSINESS.

4 Watch for state specific variables. If a question is NOTapplicable in a certain state, the question MUST NOTbe asked nor answered and it MUST BE LEFT BLANK.

4 Use the following page (sample page shown below) ofthis form / application to provide specific details for anyquestions that were answered “yes.”

APPLICATION FOR LIFE INSURANCE (ORD 96200)

Part Two/Sections C — D

6



Signatures

4If the owner is a trust, the trust should be in effect prior to submitting the application.

4Form (COMB 86044) must be submitted if the owner is a trust.

4Enter the state where signed and the current date.

4Signature of the proposed insured.

4Signature of the policyowner. If the policyowner is an entity, list the name of the entity, obtain the signature of the entity representative, and list the title of the entity representative.

4Signature of the producer.

Tax Certification

4This line applies to both entities and individuals. Ensure this box is checked ONLY when the policyowner is subject to backup withholding.

4This line applies to both entities and individuals. An entity should consider itself a U.S. person if it is established as a United States domestic corporation. If this box is not checked, a W8 MUST be submitted for the policyowner.

4I am subject to backup withholding under Section 3406(a)(1)(C) of the Internal Revenue Code.

4 I am not a U.S. person (including U.S. resident alien), submit the applicable Form W-8 (BEN, BEN-E, ECI, EXP, or IMY). In most cases, Form W-8BEN will be the appropriate form.


4The state where the application is physically signed and the policy will be delivered determines the state of sale and dictates which application version to use. The producer must be licensed in this state.

7



Authorization to ReleaseInformation

4Enter the name of proposed insured.

4Enter the policy number (if available).

4Proposed Insured MUST sign and date (parent/guardian when the proposed insured is under 18).

Limited InsuranceAgreement (LIA)

4Checks can be made payable to Prudential Insurance.

4Complete this section if prepayment can and will be collected.

4Enter the amount of insurance requested.

4If a term conversion, show the amount of the new policy in the amount of insurance requested.

4If requesting a flex face increase (VAL) or a layer/slice (VUL), show only the amount of the flex face increase or layer/slice requested.

4Enter the amount of prepayment.

4Enter the proposed insured’s name.

4Prudential must receive payment, the LIA, and the request for coverage on the same day. Prepayments are not accepted after the application is submitted.

Signatures

4If the owner is a business, a company officer must sign and include their title.

4Proposed insured must sign and date this section/form (if under 18, parent/guardian signs).

4If the policyowner is different from the insured, the policyowner must sign.

4If a trust is the owner, all trustees must sign unless otherwise stated in the trust or applicable state laws. They must also indicate “trustee under trust agreement dated _____.”

4The producer must sign.

AUTHORIZATION TO RELEASE INFORMATION (ORD 96200C) & LIMITED INSURANCE AGREEMENT (ORD 96200A)

Note

4When you print the application packet, you will find one copy of both the Authorization to Release Information and the Limited Insurance Agreement. Once finished, provide a copy of the Authorization to Release Information and the Limited Insurance Agreement (if a prepayment was taken) to the client. Submit the original(s) with the completed application.

8



Name of Proposed Insured 4Enter name of the primary proposed insured.

Purpose of Life Insurance

4Frequently, the purpose of the insurance is not clear, which can cause a delay in processing the application.

4Check all that apply and explain. (The cover letter is a good place to include additional information about amounts, breakdowns, and purpose).

Producer Information 4Provide all requested information applicable.

Case Details 4Check applicable boxes for requirements.

Knowledge of Proposed Insured 4Answer all Questions. Check applicable boxes for requirements.

Suitability Declarations 4Applicable only to variable products.

4Answer all questions.

Source of Funds4Enter the source of BOTH the initial and future premiums.

4Answer questions 2 and 3 only premiums (either initial or future) are coming from any existing policies or contracts.

Underwriting CategoryQuoted

4Check the applicable box.

Prudential/Pruco Policies Issued Within Three Months

4This needs to be answered only if a Pru/Pruco policy was issued within three months of the current application.

Remarks

4This section is often left blank yet remarks are helpful to expedite processing (e.g., a cross-reference to related applications on business partners, or stating who suggested coverage, etc.).

4Enter any/all unusual details or subjective information you learn about all the proposed insureds in this section.

Military 4Both questions MUST be answered on ALL cases. For any YES answers, provide appropriate disclosure forms at point of sale.

Producer’s Statement

4Sign and date.

4For a non-face-to-face sale: Producer should select NO in section I, question 1 of the Agent’s Report, noting the insured was NOT seen at the point of sale.

AGENT’S REPORT (this form MUST be submitted with the application in all cases)

9


APPLICATION SIGNATURE REQUIREMENTS

FORM: Limited Insurance Agreement (ORD 96200A)

Section Proposed Insured Policyowner(s) Trustees Officer Producer

rIf age 18 or over;otherwise, parent/guardian. Include date signed.

rIf different from theproposed insured.

rIf a trust is the owner, all trustees must signunless otherwise stated in the trust orapplicable state laws.

rOfficer of company, ifowner is a business or corporation.

r

FORM: Application for Life Insurance (ORD 96200)


r

rIf different from theproposed insured.If the owner is an entity, give the entity’s name.

rIf a trust is the owner, all trustees must signunless otherwise stated in the trust orapplicable state laws.They must also indicate “trustee under trust agreement dated _____.”

rOfficer (include title) of company, if owner is a business or corporation.

r

10

FORM: Authorization to Release Information (ORD 96200C)


rIf age 18 or over;otherwise, parent/guardian. Include date signed.


ADDITIONAL FORMS

OBTAINING FORMS

Forms may be accessed on-line via the “Forms” tab at www.Pruxpress.com. Click on the “Forms” tab and then “Launch Forms.”

Be careful to select the appropriate state-specific version(s).

Form Name/Type Form Number When To Use

Aviation Supplement ORD 96200 Aviation Required if the proposed insured has any duties aboard an aircraft, glider, balloon, or similar device.

Diving Supplement ORD 96200 Diving Required if the proposed insured participates in scuba diving.

Mountain ClimbingSupplement ORD 96200 Mountain Climbing Required if the proposed insured participates in mountain climbing.

Motorized Vehicle RacingSupplement ORD 96200 Racing

Required if the proposed insured participates in any form of motorized vehicle racing.

General AvocationSupplement ORD 96200 Avocation

Required if the proposed insured participates in any hazardous activities other than scuba diving, mountain climbing, or racing.

Business Supplement ORD 96200 Business Required when the owner or beneficiary of the policy is to be a business.

Financial Supplement ORD 96200 FinancialRequired when the face amount is $5,000,000 or greater for ages 18 to 70, $2,500,000 or more for ages 71 to 80, and $1,000,000 or more for age 80 and older.

BenefitAccess Rider Supplement ORD 96200 BenefitAccess Rider

Complete when submitting for BenefitAccess Rider on UL Protector (Type A death benefit), PruLife® Index Advantage UL, PruLife® Founders Plus UL, PruLife® Custom Premier II or VUL Protector products.

Child Rider Supplement ORD 96200 Child Rider Required when requesting a Child Rider.

Policyowner StatementSupplement ORD 96200 Owner Statement Required for all non-variable plans when the age of the proposed insured is

70 or greater and the face amount is $1,000,000 or greater.

Policy Change Supplement ORD 96200 Change

Required only when:

• The existing policyowner of the policy being converted or changed is not the owner of the new or changed policy; or

• The rights restriction requires the beneficiary to sign all requests; or

• There is a collateral assignee.

Indexed Universal LifeInsurance Supplement ORD 96200-2015 Indexed UL Required when requesting an indexed product (such as Index Advantage

Universal Life).

Founders Plus Universal Life Insurance Supplement ORD 96200 Founders Plus UL Required when requesting Founders Plus Universal Life.

Variable Supplement ORD 96200 Variable Required when requesting a variable product (such as VUL II or VUL Protector).

Absolute Assignment to Effect a Section 1035Exchange

ORD 88649 Complete only when requesting a 1035 Exchange from a non-Prudential contract.

CVAT or GPT SelectionForm ORD 99767

Required when the application state is New York for any product that offers a choice of definition of life insurance:

• CVAT: Cash Value Accumulation Test

• GPT: Guideline Premium Test

Request for InitialPremium (E-Pay) and/or toEstablish MonthlyElectronic Funds Transfer(EFT)

ORD 114416Complete if the policyowner wants to pay the initial premium from E-Pay and/or place the policy on the Electronic Funds Transfer (EFT) premium payment option.

11


ADDITIONAL FORMS (continued)

Form Name/Type Form Number When To Use

Illustration Certification ORD 96599

A signed illustration is required to be submitted with the application to satisfy NAIC Regulations. The Illustration Certification Form may be submitted with the application for Universal policies if the illustration shown to the applicant differs from the policy applied for or a computer screen illustration was shown to the client. If an Illustration Certification is used, an illustration conforming to the policy as applied for must be provided to the applicant within 48 hours.

Important Notice Regarding Replacements COMB 89216

Form must be completed and submitted when:

4Replacing existing life or annuity coverage as required by state regulations.

4The proposed insured has existing individual life or annuity coverage (even if not replacing it) and the application state has adopted the NAIC’s New Model Replacement Regulation.

4Additional replacement forms may also be required.

Living Needs BenefitSM—Get the Most Out of YourLife Insurance

ORD 87246If applying for the Living Needs Benefit (LNB), provide the primary proposed insured with a copy of the LNB brochure (found on Pruxpress).

New York Definition ofReplacement COMB 98774–NY

Required to be completed/signed by the owner when the application is signed in the state of New York. (Applies to all products.)

Pennsylvania DisclosureStatement COMB 96999–PA

Required for all products except VUL II. Producer completes the form and provides a copy to the proposed insured and submits a copy to the Home Office only if replacing an existing non-Prudential policy. No signatures are required.

Preliminary Statement ofPolicy Cost (Maine and New York)

ORD 99607

ORD 99606

4Maine: ORD 99607 must be completed for all Term policies.

4New York: ORD 99606 must be completed and signed by both the owner and producer for all Term policies with a copy submitted to the Home Office with the application.

Premium Provisions ofIndeterminate PremiumContracts (Montanaand Texas)

ORD 86890Required for Term Essential in Montana and Texas. Form must be signed by the owner and a copy must be submitted to the Home Office with the application.

Trustee Statement andAgreement Form COMB 86044

• Use for ownership in a trustee under a trust agreement.

• COMB 86044 is preferred over a trust document.

Disclosure for MilitarySales ORD 114442 Required when the military question on the Agent’s Report is answered YES.

The Prudential Insurance Company of America, Newark, NJ.

NOT FOR CONSUMER USE.12

The Living Needs BenefitSM is an accelerated death benefit and is not a health, nursing home, or long-term care insurance benefit and is not designed to eliminate the need for insurance of these types. There is no charge for this rider but, when a claim is paid under this rider, the death benefit is reduced for early payment, and a $150 processing fee ($100 in Florida) is deducted. If more than one policy is used for the claim, each policy will have a processing fee of up to $150 deducted ($100 in Florida). Portions of the Living Needs Benefit payment may be taxable, and receiving an accelerated death benefit may affect eligibility for public assistance programs. The federal income tax treatment of payments made under this rider depends upon whether the insured is the recipient of the benefit and is considered “terminally ill” or “chronically ill.” We suggest that clients seek assistance from a personal tax advisor regarding the implications of receiving Living Needs Benefit payments. This rider is not available in Minnesota to new purchasers over age 65 until the policy has been in force for one year, and the nursing home option is not available in Connecticut, Florida, Massachusetts, New York or the District of Columbia. This rider is not available in Washington state. In Oregon, term policies must include the waiver of premium benefit to be eligible for this rider.

purpose of this guide - prudential...

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