Please click on the appropriate form listed below. Once completed,
hit SUBMIT and it will be sent directly to us.
This form is for all Individual Short Term proposals.
This form is for all Individual Long Term Proposals and all Business Overhead Expense cases.
This form is for Buy / Sell monthly, down payment, or lump sum benefit amount proposals.
Use this form for cases with three or more lives and for which
you would like to propose an executive carve out program, a retirement completion
program, a group supplement program, or other type of multi-life disability
income benefit program. This form will allow us to negotiate/request Guarantee Issue
or Simplified offers from the insurance carriers. Additionally, a census in an Excel
Spreadsheet is required including:
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Company Name and Address
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Employee Name (First, Last)
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Sex
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DOB |
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Resident State |
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Occupation |
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Salary |
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Bonus/ Commission |
Click here for our pre-formatted
excel spread sheet census form.
Once completed, please e-mail census to
info@drgdi.com.
Please feel free to contact us at 800-945-9719 to discuss the case, underwriting
concerns, program design, and competition and carrier selection.
General turn around time is within 24 hours for most Individual / Business
Overhead and Buy-Sell requests.
Please allow additional time for Multi-Life requests.
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