This worksheet is necessary to initiate underwriting. Complete all information before you call the company verification line or complete the e-app. It contains sensitive information — do not send in this form. Nothing you type here is kept on this page: if you close or refresh before you save, it is gone. Use Save to CRM, Copy Summary, or Download Summary at the bottom before you leave.
SSN, driver’s license / state ID number, and bank account & routing numbers are not fields here. Collect those on the verification call or in the e-app only, the same as the paper worksheet directs. Beneficiary SSNs are also left off.
Agent & Case File
Who is working the case, and where it will be issued.
Proposed Insured
Primary insured in full. Add household members below — the paper form carries five names.
Primary Insured
Owner — complete only if Owner / Applicant is different from Proposed Insured
Owner SSN and license number are not collected on this page — verification call / e-app only.
Health Questions
Ask exactly as written on the worksheet. Every “Yes” needs a note in the summary before underwriting.
Current Medications
Every medication the applicant is currently taking, and what it is for.
Permanent Coverage — Options Presented
The six points from the worksheet, then the benefit and premium options you put in front of the client.
- PERMANENT COVERAGE that protects you your whole life. Premiums NEVER increase. Benefits NEVER decrease.
- You’re PROTECTED from THE FIRST DAY your policy is in effect.
- Policy NEVER EXPIRES or cancels (as long as premiums are paid).
- Coverage CAN NOT BE CANCELLED because of age or health changes.
- BENEFITS PAY OUT within a few business days of claim approval.
- When questions or changes arise your agent is there READY TO HELP.
Plan & Payment Info
Plan and draft timing only. Bank name, account, and routing are collected on the verification call — never here.
Name as it appears on the account, financial institution, account type, routing, and account number: verification call / e-app only.
Beneficiaries
Primary and contingent, with each person’s share of proceeds.
Shares entered: 0%
Replacement
If applicable — current or pending coverage, and whether this application replaces or changes it.
Emergency Contact Sheet
So the family knows who to call, and the policy never goes unclaimed.
According to the National Unclaimed Property Network, twenty percent (20%) of all life insurance policies become lost and are turned over to State Unclaimed Property Departments, because surviving family members never knew the policies existed. Millions of dollars in life insurance go unclaimed every year. As an additional service, we will contact your local emergency contact list, provide them with our contact information and a business card, so your family will not be alone when the time comes — and will know who to contact to make sure your policy does not go unclaimed.
Finish the Case
Save the case to the CRM, or take the summary with you — the page itself keeps nothing.
To print or save a PDF, use your browser’s own Print command — the worksheet is laid out print-clean.
Save to CRM needs the proposed insured’s name plus an email or a phone (Section 2) — the same rule as the Underwriting Co-Pilot’s New Client save. You can also paste the summary into your own notes yourself.
Watts Unified Solutions · Client Worksheet — Pre-Qualifying · Agent use only · Faith Leads. Structure Protects. Legacy Lasts.