{\rtf1\mac\ansicpg10000\uc1 \deff0\deflang1033\deflangfe1033{\upr{\fonttbl{\f0\fnil\fcharset256\fprq2{\*\panose 00020206030504050203}Times New Roman;}{\f1\fnil\fcharset256\fprq2{\*\panose 00020b06040202020202}Arial;}
}{\*\ud{\fonttbl{\f0\fnil\fcharset256\fprq2{\*\panose 00020206030504050203}Times New Roman;}{\f1\fnil\fcharset256\fprq2{\*\panose 00020b06040202020202}Arial;}}}}{\colortbl;\red0\green0\blue0;\red0\green0\blue255;\red0\green255\blue255;
\red0\green255\blue0;\red255\green0\blue255;\red255\green0\blue0;\red255\green255\blue0;\red255\green255\blue255;\red0\green0\blue128;\red0\green128\blue128;\red0\green128\blue0;\red128\green0\blue128;\red128\green0\blue0;\red128\green128\blue0;
\red128\green128\blue128;\red192\green192\blue192;}{\stylesheet{\nowidctlpar\faauto\adjustright\rin0\lin0\itap0 \fs20\lang1033\cgrid \snext0 Normal;}{\*\cs10 \additive Default Paragraph Font;}}{\info
{\title Annuity / Settlement Payments Submission Worksheet}{\author Karen Knott}{\operator George Karl}{\creatim\yr2003\mo2\dy13\hr16\min7}{\revtim\yr2003\mo2\dy13\hr16\min7}{\printim\yr1998\mo4\dy23\hr12}{\version2}{\edmins0}{\nofpages1}{\nofwords128}
{\nofchars732}{\*\company Pino Training Organization}{\nofcharsws898}{\vern16411}}\margl1440\margr1440 \ftnbj\aenddoc\ftnrestart\noxlattoyen\expshrtn\noultrlspc\dntblnsbdb\nospaceforul\hyphcaps0\horzdoc\dgmargin\dghspace120\dgvspace120\dghorigin1440
\dgvorigin1440\dghshow0\dgvshow3\jcompress\viewkind1\viewscale150\nolnhtadjtbl \fet0\sectd \sbknone\linex0\endnhere\sectdefaultcl {\*\pnseclvl1\pnucrm\pnstart1\pnindent720\pnhang{\pntxta .}}{\*\pnseclvl2\pnucltr\pnstart1\pnindent720\pnhang{\pntxta .}}
{\*\pnseclvl3\pndec\pnstart1\pnindent720\pnhang{\pntxta .}}{\*\pnseclvl4\pnlcltr\pnstart1\pnindent720\pnhang{\pntxta )}}{\*\pnseclvl5\pndec\pnstart1\pnindent720\pnhang{\pntxtb (}{\pntxta )}}{\*\pnseclvl6\pnlcltr\pnstart1\pnindent720\pnhang{\pntxtb (}
{\pntxta )}}{\*\pnseclvl7\pnlcrm\pnstart1\pnindent720\pnhang{\pntxtb (}{\pntxta )}}{\*\pnseclvl8\pnlcltr\pnstart1\pnindent720\pnhang{\pntxtb (}{\pntxta )}}{\*\pnseclvl9\pnlcrm\pnstart1\pnindent720\pnhang{\pntxtb (}{\pntxta )}}\pard\plain 
\qc\nowidctlpar\faauto\adjustright\rin0\lin0\itap0 \fs20\lang1033\cgrid {\b\f1\fs24 Annuity / Settlement Payments Submission Worksheet
\par }{\f1\fs24 
\par }\pard \nowidctlpar\tldot\tx9187\tx10800\faauto\adjustright\rin0\lin0\itap0 {\f1\fs24 
\par }\pard \sl300\slmult0\nowidctlpar\tldot\tx4680\tldot\tx9187\tx10800\faauto\adjustright\rin0\lin0\itap0 {\b\f1\fs24 CCFC/Referral Representative Information
\par 
\par }\pard \sl300\slmult0\nowidctlpar\tlul\tx6930\tlul\tx9187\faauto\adjustright\rin0\lin0\itap0 {\f1\fs24 Name\tab Date\tab 
\par }\pard \sl300\slmult0\nowidctlpar\tlul\tx9187\faauto\adjustright\rin0\lin0\itap0 {\f1\fs24 Company\tab \tab 
\par Address \tab \tab 
\par }\pard \sl300\slmult0\nowidctlpar\tlul\tx4680\tx5040\tlul\tx9187\faauto\adjustright\rin0\lin0\itap0 {\f1\fs24 City\tab  State ___________ ZIP\tab 
\par Phone \tab  Fax\tab }{\b\f1\fs24 
\par }\pard \sl300\slmult0\nowidctlpar\tldot\tx4680\tx5040\tldot\tx9187\tx10800\faauto\adjustright\rin0\lin0\itap0 {\f1\fs24 
\par }{\b\f1\fs24 Client Information
\par }{\f1\fs24 
\par }\pard \sl300\slmult0\nowidctlpar\tlul\tx4680\tx5040\tlul\tx9187\faauto\adjustright\rin0\lin0\itap0 {\f1\fs24 Name \tab  Social Security Number\tab 
\par }\pard \sl300\slmult0\nowidctlpar\tlul\tx9187\faauto\adjustright\rin0\lin0\itap0 {\f1\fs24 Address \tab 
\par }\pard \sl300\slmult0\nowidctlpar\tlul\tx4680\tlul\tx9187\faauto\adjustright\rin0\lin0\itap0 {\f1\fs24 City\tab }{\f1\fs24 State ___________ }{\f1\fs24 ZIP\tab 
\par Phone \tab Date of birth\tab  }{\b\f1\fs24 
\par }\pard \sl300\slmult0\nowidctlpar\tlul\tx9187\faauto\adjustright\rin0\lin0\itap0 {\f1\fs24 Driver\rquote s license number and state\tab \tab 
\par Marital status\tab \tab 
\par Attorney\rquote s name (if applicable)\tab \tab 
\par Is payment a disability pension?\tab \tab 
\par If so, does disabled pensioner have a second source of income?\tab 
\par Is client providing life insurance? \tab \tab 
\par If so, amount of coverage\tab \tab 
\par }\pard \sl300\slmult0\nowidctlpar\tldot\tx4680\tldot\tx9187\tx10800\faauto\adjustright\rin0\lin0\itap0 {\f1\fs24 
\par }{\b\f1\fs24 Payment Information}{\f1\fs24 
\par }\pard \sl300\slmult0\nowidctlpar\tldot\tx9187\tx10800\faauto\adjustright\rin0\lin0\itap0 {\f1\fs24 
\par }\pard \sl300\slmult0\nowidctlpar\tlul\tx9187\faauto\adjustright\rin0\lin0\itap0 {\f1\fs24 Annuity payor\tab 
\par Gross payment amount\tab 
\par Tax deductions: Federal __________________ State\tab 
\par Other deductions from gross: Description ______________Amount\tab 
\par Frequency of payments (number of months or years)\tab 
\par Date of next anticipated payment\tab 
\par 
\par }{\b\f1\fs24 Client\rquote s Need}{\f1\fs24 
\par 
\par What is the client\rquote s motivation?\tab 
\par \tab 
\par How much cash does the client need or want?\tab 
\par }\pard \sl300\slmult0\nowidctlpar\tldot\tx9187\tx10800\faauto\adjustright\rin0\lin0\itap0 {\f1\fs24 
\par }{\f1 /annuity}{
\par }}