Please list proposed death benefit.

Please list annual salary

i.e. The Group disability insurance may cover 60% of base compensation to a cap of a specific dollar amount.

i.e. The Group disability insurance may cover 60% of base compensation to a cap of a specific dollar amount.

Please list average bonus compensation.

Please list annual business and/or 1099 income.

Please list ownership value of proposed insured. For professional services, you may use ownership value of annual gross receipts.