Atlantic Financial Settlements
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If you are considering letting your policy lapse, first consider converting it into cash!

In today's complex and rapidly changing world, many of the reasons why people originally purchased life insurance may have changed, or you may have purchased life insurance while your were working and now find it undesirable to continue paying the premiums now that you are retired or that your children have grown. You now have a powerful financial option not available anywhere else that will allow you to convert an unwanted asset into a cash asset!

Please fill out this questionnaire if you are interested in recieving more information.

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Policy Holders Information

First Name: Last Name:

Date of Birth: / / (MM/DD/YY)

Face Amount of Policy:

Premium Amount: $ Frequency:

Issue Date: / / (MM/DD/YY)

Current Health Condition (check one): Excellent Good Fair Poor

Phone Number:

Street Address:

City: State: Zip Code:

Contact me by (check one): Phone Mail Fax E-mail

E-mail Address: Fax Number:

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