National Insurance Brokerage | NIB

This web site is for insurance agents and financial professionals only; not for use with the public. National Insurance Brokerage, LLC is a Florida licensed life insurance agency that does business under the name NB Life Insurance Services, LLC in California, NB Life Insurance Services in Georgia, NIB Insurance Brokerage in New York, and NIB Insurance Brokerage, LLC in Texas.

National Insurance Brokerage, LLC is a subsidiary of National Financial Partners Corp. National Financial Partners Corp. and its subsidiaries do not give tax or legal advice. Any case discussions are general in nature and are not intended to be construed as advice. Please consult financial professionals familiar with your personal situation prior to making any changes in your own investment strategy or insurance purchases.

If you have any questions about the National Insurance Brokerage web site please contact David Rodriguez at 1-800-561-4148 ext. 1112.

Illustration Request Form
Instructions: Please fill out the *required fields listed in red for your illustration request. This information will help us provide you with the best performing illustrations to meet your client's primary objective. Please only use the additional fields if you need a more specific illustration. Our illustration department or your internal NIB representative will follow up with you to discuss the case. Thank you.
PRODUCER:
Producer Name *
Phone *
Email *
Address *
City *
State *
Zip Code *
Internal NIB Rep
Broker/Dealer
Return Method	Email Fax Broker Pickup Postal Mail
INSURED #1 Section
Name *
Birth Date *	(mm/dd/yyyy)
Gender *	Male Female
Health Class *	Preferred Best Preferred Standard Sub-Standard
Tobacco Use *	None Cigarette Pipe Cigar Chewing
Enter Date Last Used	(mm/dd/yyyy)
Medical problems
Medications & Usage

INSURED #2 - For Survivorship cases only
Name *
Birth Date *	(mm/dd/yyyy)
Gender *	Male Female
Health Class *	Preferred Best Preferred Standard Sub-Standard
Tobacco Use *	None Cigarette Pipe Cigar Chewing
Enter Date Last Used	(mm/dd/yyyy)
Medical problems
Medications & Usage

Illustration Section
Primary Objective *	Cash Accumulation Guarantees Low Premium
Solve For *	Face Amount Premium Amount
Amount: *
Premium amount(s)
Specified Carrier
Product Type *	Universal Life Whole Life Whole Life Blend %Term Variable Survivorship Other
Term	ART 5 10 15 20 30 Other
Payment Plan	Single Level # of Years Pay to Age
Goal	Endow Alternative Amount at Maturity
Guarantee For	Life # of Years To Age
Interest/Div. Rate	Current Other : %
Payment Mode	Annual Semi-Annual Quarterly Monthly
State of Issue *
Riders	Waiver of Premium Child Insurance: Accelerated Death Benefit: Other :
Special Instructions

National Insurance Brokerage, LLC

Alternative content