Facebook Conversions + White Swan

ID of Plan Request(s) to Associate Information With

First Name

Middle Name

Last Name

Gender

Date of Birth

Country of Birth

State of Birth

Personal Phone

Workplace Phone

Email

Current Address

Insured is US Citizen/Permanent Resident?

Details on Citizenship (if not US citizen/resident)

Marital Status

Drivers License Number

Drivers License State

Drivers License Expiration Date

Social Security Number/Tax ID Number

Current Occupation

Current Employer

Number of Years at Current Job

Workplace Zip Code

Best Time to Call Intended Insured

Split Death Benefit Equally

Percentage of Death Benefit

Relationship to Insured

Type of Relationship (Other)

Legal Entity or Individual?

Name of Children/Grandchildren

Individual/Contact Person Name

Entity Name

Beneficiary SSN/EIN/TIN

Beneficiary Date of Birth

Beneficiary Phone Number

Same Address as Insured?

Address

Purpose of Insurance

Owner Same as Insured?

Is Owner Individual or Entity?

Owner Relationship to Insured Person

Owner Individual/Entity Name

Owner EIN/TIN

Owner Entity Contact Person

Owner Address

Owner Email

Owner Phone

Owner Date of Birth

Will Owner Pay Premiums With Income?

Source of Premium Payments

Owner Estimated Annual Income

Spouse of Owner Estimated Annual Income

Household Estimated Total Assets

Household Estimated Liquid Assets

Household Estimated Total Liabilities

Has Owner Declared Bankruptcy

Bankruptcy Details

Has Owner Been Discharged From Bankruptcy

Is Owner Subject to Backup Withholding?

Insurance Carrier

Current Death Benefit

Policy Type

Policy Number

Year Issued

Reason for Replacement

Plans to Terminate Existing Policies on Insured Person

Plans to Use Existing Policies to Fund New Policy

Opt for Temporary Insurance Coverage

Accumulation Goal (Variable Life Application Only)

Cash Access Timeline (Variable Life Application Only)

Normal Conditions Investment Expectations (Variable Life Application Only)

Poor Conditions Investment Expectations (Variable Life Application Only)

3 Year Investment Expectations (Variable Life Application Only)

3 Month Investment Expectations (Variable Life Application Only)

Client Email

User Email

Name

Email

Phone Number

Intended Insured Name

Second Insured Name

Policy type

Main Goal

Embed URL

Turbo Request Mode (Skip Extras Section)

Pre-fill Application Data ID

Custom Success Page (URL)

Case Associated Person (Email)

Resident State

Death Benefit Need

Payment Schedule

Paid Up Period

Term Life Coverage Period

Premium Budget

Gender

Second Insured Gender

Health Rating

Second Insured Health Rating

Date of Birth

Second Insured Date of Birth

Insured Uses Tobacco/Nicotine

Second Insured Uses Tobacco/Nicotine

Insured Uses Marijuana/THC

Second Insured Uses Marijuana/THC

Insured Height in Feet

Insured Height in Inches

Second Insured Height in Feet

Second Insured Height in Inches

Insured Weight in Pounds

Second Insured Weight in Pounds

Risk Profile (Only Variable Universal Life)

Expedited Product Preference

Convertability Preference (Term life only)

Riders for the Plan

Supplemental Term Coverage Length

Supplemental Term Amount

Room for additional premium

One-Time Deposit Amount

Uncapped Account Preference (Only Indexed Universal Life)

Fee Account Preference (Only Indexed Universal Life)

Planned Retirement Income

Starting Age of Retirement Income

Years of Retirement Income

Custom Allocation Mix

Account Type

Allocation Percentage

White Swan Follow Up

Who Receives Communications for Case

Plan Comment

User Email

Client Email

Lookback Period in Days