Immediate Annuity - Swiss Insurance Partners

Thank you for requesting a personal quotation via Internet.

This form is designed for your convenience and to handle your request most efficiently. Please tick the appropriate boxes and fill in the relevant fields according to your individual needs.

Please note that Swiss insurance policies can be tailor-made to suit the most individual needs. There are many extra features available such as premium waivers in case of disability or death, annuity reduction for joint annuitants, etc. Please contact us for individual advice and assistance to provide you with the best solution.

The Immediate Annuity will secure a regular income for life - starting immediately.

	Yes, I would like to receive a personal quotation for an Immediate Annuity on
		one life (annuities are paid until the insured person dies)
		joint life (annuities are paid, in the absence of any special options, until the two insured persons die)

Insured person 1st insured person
Date of birth*	/ /
Gender*
Country of residence*
Nationality*

2nd insured person
Date of birth*	/ /
Gender*
Country of residence*
Nationality*


Annuity specifications
	with refund (refund of all or a portion of the purchase price in the event of the annuitant's premature death)
	without refund (no refund in case of premature death)
Currency*
Premium payment and start of annuity payments*		/ /

Quotation option
a)	I would like to pay a single premium of
		minimum of USD 250'000 or equivalent
	You will receive a quotation for a yearly pay-out (annuity).
b)	I would like to receive a yearly pay-out (annuity) of
			minimum of USD 10'000 or equivalent
	You will receive a quotation for a single premium.

Do you have any specific questions?

How did you find us?
Please let us know how you found or heard about us. Thank you!

I was referred by (please indicate who recommended us to you)
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Contact information
Please send my personal quotation to the following address:

Salutation*
First name*
Last name*
Street or PO box
Post code
Place/City*
Country*
Telephone number (incl. country code)*
Fax number
E-mail*
Confirm e-mail*
Preferred correspondence language*
Additional information

*required information

Important Note: All information is treated with highest confidentiality once received by us. However, data contained in this form may be viewed by third parties while in transit. For maximum information security print this form and send it by fax or mail.

Due to international differences in legislation and regulatory constraints, Swiss Insurance Partners make no warranty of any kind, express or implied, regarding the availability of any product or insurance scheme in any country.