PDF0 1

12/07/2011
02:40:11 PM
CT PACKAGE
CRISTINA SIMAO 755
LS01451912 SUSAN SKENE CAITLIN LAVIANA CORINNE LAVIANA SPENSER LAVIANA
DOCUMENTS PRINTED:
q q q q q q q q MAIL SLIP COVER LETTER - #48 (LIFE ILLUSTRATION ONLY) (03-05) LT10/10 (2011) ILLUSTRATION - SUSAN SKENE LT10/10 (2011) ILLUSTRATION - CAITLIN LAVIANA LT10/10 (2011) ILLUSTRATION - CORINNE LAVIANA LT10/10 (2011) ILLUSTRATION - SPENSER LAVIANA L657-7 LT (2011) TOMBSTONE HOW MUCH IS ENOUGH
DOCUMENTS TO PICK & SPECIAL HANDLING:

q NEW AMICA LIFE BROCHURE L831-1
Jeffrey Laviana 203 Hudson St Berlin, CT 06037
If you received this information via e-mail or fax, the return mailing address for applications, forms, and other correspondence is:
Attention: New Business Unit (for life insurance only) or Life Customer Service (for annuities only)
December 7, 2011
Jeffrey Laviana 203 Hudson St Berlin, CT 06037
Dear Jeff, It was a pleasure speaking with you about Amica Life's products and services. As promised, here is your personalized Amica Life Insurance Kit. Inside, you'll find information to help you take the next step towards financial security for your family. If you have any questions or need assistance, please don't hesitate to call me toll-free at 1-800-234-5433, extension 89331.
Your Life Insurance Illustration: Refer to this customized illustration / quote for details about
your proposed insurance coverage. For your convenience, on the cover page of each illustration is a detailed summary of the coverage being quoted. Please note that the premium quoted is based on preliminary information gathered, and your final premium offer / rate will be determined after the underwriting process is complete.
How Much Life Insurance Do You Need To Protect Your Family?: Completing this simple
worksheet can help provide you with an estimate of the amount of life insurance you may need to ensure that your family is adequately protected. Most people find the few minutes invested is time well spent. After you have reviewed this information, we can begin the application process by together completing the necessary forms over the telephone. If I do not hear from you within a few days, I will call you to follow-up and continue the process. At Amica Life, we are commited to providing you with the professional service, competitive rates, and quality coverage you need to protect your family's dreams. If there is anything else you need, please do not hesitate to contact me. Sincerely,
Cristina Simao Sales Development Representative Amica Life Insurance Company Amica General Agency, Inc.
LIFE INSURANCE QUOTATION

PREPARED FOR: Susan Skene
Plan Summary:
PLAN
OF
AMOUNT
OF
INSURED
INSURANCE
INSURANCE
PREMIUM GUARANTEE PERIOD *
METHOD
OF
PAYMENT
MONTHLY CONTRACT PREMIUM
Susan Skene
10 Year Level Term (with Cost-of-Living Benefit)
$100,000
10 Years
Monthly
$29.25
Age 55, Female; Preferred Rate

BENEFIT RIDERS AVAILABLE MONTHLY RIDER PREMIUM
( ) Waiver of Premium Benefit ( x ) Children's Insurance Benefit: 10 unit(s)
$16.67 $3.96
Not included $3.96
TOTAL MONTHLY CONTRACT PREMIUM
$33.21#
ALTERNATE METHODS OF PAYMENT
ANNUAL SEMI-ANNUAL QUARTERLY
$398.50 $202.25 $102.63
* Premiums increase annually after the 10th year. # The premium quoted above is based on preliminary information gathered, and your final premium offer / rate will be determined after the underwriting process is complete. All sales representatives for Amica Life Insurance Company are employees of the company. Any compensation paid to our employees for services provided to you (including your purchase of any life insurance or annuity contracts from Amica Life) is paid entirely by Amica Life. You will never be charged a separate fee for any such services or purchases.
PRESENTED BY:
REPRESENTING:
PREPARED BY:
Cristina Simao 10 Amica Center Boulevard Lincoln, Rhode Island 02865-1165 (800) 234-5433 ext. 89331 Wednesday, December 07, 2011
Amica Life Insurance Company PO Box 6008 Providence, RI 02940-6008
Cristina Simao
CT Version

10 YEAR LEVEL TERM PREPARED FOR: SUSAN SKENE GUARANTEED PREMIUMS -- SUPPLEMENTAL TABULAR DETAILS Gender: Age: Rate Class: Female 55 Preferred Class Amount of Insurance: Total Monthly Contract Premium: Premium Guarantee Period: $100,000 $33.21 10 Years
Benefit Riders Available: ( ) Waiver of Premium Benefit ( x ) Children's Insurance Benefit: 10 unit(s)
Not included $3.96
End of Year
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30
Age
56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85
Guaranteed Death Benefit

$100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000
Guaranteed * Maximum Premium

$398.52 398.52 398.52 398.52 398.52 398.52 398.52 398.52 398.52 398.52 3,456.00 3,750.00 4,077.00 4,440.00 4,836.00 5,283.00 5,793.00 6,351.00 6,960.00 7,635.00 8,376.00 9,189.00 10,089.00 11,070.00 12,147.00 13,485.00 15,129.00 16,869.00 18,696.00 20,733.00
Prepared by: Cristina Simao December 07, 2011
Representing: Amica Life Insurance Company CT Version Page 1 of 2

10 YEAR LEVEL TERM PREPARED FOR: SUSAN SKENE GUARANTEED PREMIUMS -- SUPPLEMENTAL TABULAR DETAILS
End of Year
31 32 33 34 35 36 37 38 39 40
Age
86 87 88 89 90 91 92 93 94 95
Guaranteed Death Benefit

$100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000 100,000
Guaranteed * Maximum Premium

$22,797.00 25,236.00 28,248.00 31,425.00 34,587.00 36,915.00 39,141.00 42,831.00 47,832.00 54,060.00
* For years 11 and later, this plan provides for premiums which may be less than the guaranteed maximum premiums shown above.
Prepared by: Cristina Simao December 07, 2011
Representing: Amica Life Insurance Company CT Version Page 2 of 2

PREPARED FOR: Caitlin Laviana
Plan Summary:
PLAN
OF
AMOUNT
OF
INSURED
INSURANCE
INSURANCE
METHOD
OF
PAYMENT
Caitlin Laviana
$100,000
10 Years
Monthly
$8.92
Age 24, Female; Preferred Select Rate

( (
) Waiver of Premium Benefit ) Children's Insurance Benefit: 10 unit(s)
$1.42 $3.96
Not included Not included
$8.92#
$107.00 $56.50 $29.75
PRESENTED BY:
REPRESENTING:
PREPARED BY:
Cristina Simao
CT Version

PREPARED FOR: Corinne Laviana
Plan Summary:
PLAN
OF
AMOUNT
OF
INSURED
INSURANCE
INSURANCE
METHOD
OF
PAYMENT
Corinne Laviana
$100,000
10 Years
Monthly
$16.25
Age 18, Female; Standard Rate

( (
$2.58 $3.96
$16.25#
$195.00 $100.50 $51.75
PRESENTED BY:
REPRESENTING:
PREPARED BY:
Cristina Simao
CT Version

PREPARED FOR: Spenser Laviana
Plan Summary:
PLAN
OF
AMOUNT
OF
INSURED
INSURANCE
INSURANCE
METHOD
OF
PAYMENT
Spenser Laviana
$100,000
10 Years
Monthly
$11.92
Age 20, Male; Preferred Rate

( (
$1.92 $3.96
$11.92#
$143.00 $74.50 $38.75
PRESENTED BY:
REPRESENTING:
PREPARED BY:
Cristina Simao
CT Version
LEVEL TERM LIFE INSURANCE

IMPORTANT PRODUCT AND POLICY OPTION INFORMATION
PROVIDE Y OUR FAMILY WITH INCREASED
FINANCIAL SECURITY
Choose From Among Five Level Term Periods of 10, 15, 20, 25 or 30 Years
Converting to Permanent Coverage

To guarantee level-premium lifetime coverage, this policy may be converted to any permanent policy available at the time of conversion regardless of your health. Conversion is allowed up to the earlier of the policy anniversary date immediately following the insured's 65 th birthday, or the completion of 80 percent of the level-premium period. For example, the elective conversion provision expires on the: 8 policy anniversary for a 10-year Level Term policy 12th policy anniversary for a 15-year Level Term policy 16 policy anniversary for a 20-year Level Term policy 20th policy anniversary for a 25-year Level Term policy 24th policy anniversary for a 30-year Level Term policy Conversion is offered without a medical examination at rates then in effect for the new policy, based on your then current age and current rate class.
th th
Convertible Level Term* with the Annual Renewable Term provision provides level term insurance coverage to age 95. This policy can be purchased for a 10-, 15-, 20-, 25- or 30-year period. Issue ages for this policy may vary based on the term selected and your resident state at time of issue. This policy is fully convertible to any Amica Life permanent plan available without medical examination, subject to limitations of the policy's elective conversion provision.
POLICY FEATURES
Guaranteed Level Protection

You may purchase a 10-, 15-, 20-, 25- or 30-year level-premium policy with rates that are guaranteed to remain level throughout the period selected. Alternatively, the 20-, 25- and 30-year plans also offer premiums that are designed to remain level for the full term period but have a shorter premium guarantee period (10 years) and a lower cost. At the end of the level-premium period for which this policy is issued, your policy will continue in force automatically on an Annual Renewable Term basis until age 95.
POLICY B ENEFITS
Level Term has a minimum policy size of $100,000. It is designed to provide a substantial amount of level coverage for the life of the policy at very affordable rates. There is no established maximum limitation placed on the amount of life insurance coverage for which you can apply. And with the Annual Renewable Term provision available at the end of the level-premium period, coverage can be provided up to age 95.
Guaranteed Level Protection

Regardless of the term period selected, you're guaranteed the same level of protection to age 95, provided premiums are paid in accordance with the Payment of Premiums provision contained in the policy. Your coverage amount does not go down as you get older.
Discounts for Larger-sized Policies

A substantial discount is available on policies of $250,000 to $499,999. An even larger discount is available on policies of $500,000 to $999,999. Our largest discount is reserved for policies of $1,000,000 or more.
Cost of Living Provision

To offset the effects that inflation can have on your coverage, we will automatically increase the face amount on all Level Term policies (except those issued on a "special" class basis) on every second policy anniversary during the level-premium period when you are between the ages of 18 and 60. The amount of each increase will be the lesser of (a) an amount arrived at by multiplying the face amount of the policy then in effect by the cost of living factor, rounded to the nearest $1,000, or (b) $20,000. Acceptance of this increase is automatic, and no evidence of insurability is required for such increase. The first time an increase is rejected, this provision will be terminated. (Not available in some states.)
No Policy Fees
We do not charge an annual fee or any other administrative fees whatsoever. In addition, our life insurance policies are not priced to include the payment of dividends and no dividends are payable. This enables us to establish our premiums at a lower initial cost.
Excellent Health Pricing

If youre a non-nicotine user and are in excellent health, you may be able to qualify for our Premier Select rates. These are the lowest premium rates we offer for Level Term. To learn more about Amica Lifes excellent health pricing, simply ask your Amica Life representative for more detailed information.
CCD 9526
L657-7
Convenient Premium Payment Options

Amica Life offers an array of premium payment plans with some of the most flexible payment schedules available for this type of insurance one of which will fit comfortably within your budget. You can choose to pay your premiums annually, semiannually, quarterly or even monthly. Monthly payments are deducted electronically directly from your checking account.
Childrens Insurance Benefit

This benefit insures your children today, while guaranteeing their future insurability, regardless of any changes in their health. It provides the same amount of coverage for each child, stepchild or adopted child of the principal policyholder listed on the application for such coverage. Children must be at least 15 days old, but less than age 18 on the date of the application. This benefit also applies to any child born to or legally adopted by the policyholder after the application date. Coverage for children born after th the application date will commence on their 15 day of life. Coverage for children will continue until the earlier of the policy anniversary date following the childs 23rd birthday, or the policy th anniversary date following the policyholders 65 birthday. Coverage is available in $1,000 increments, with a maximum of $10,000 per child. Each childs coverage is convertible to any permanent insurance policy available at the time of conversion, for up to five times the original face amount.
H OW A RE PREMIUMS D ETERMINED?
On those plans with a fully-guaranteed level-premium period, you will never be charged more than the current premium rate during the entire level-premium period. For 20-, 25- and 30-year plans with a 10-year guarantee, the current rate is intended to remain level for the full period. However, in the 11th and subsequent policy years, premiums may increase or decrease, but will never exceed the guaranteed maximum rates. On all plans, after the level-premium period, the Annual Renewable Term provision includes both current and guaranteed maximum rates. Rates are based on the company's expectations of expenses, mortality, lapse ratios and investment earnings experience. Any increase or decrease in premium will not result in an increase or decrease in benefits. In addition, you cannot be individually singled out for premium adjustment. Current rates can be changed only if rates are changed on all Amica Life policies of your class in your state. Although we cannot promise that your current rates will not change in the future, Amica Life has never increased its rates on existing policies in the history of the company. Our premium rate structure allows us to set current rates in a very competitive manner.
Accidental Death Benefit

For an additional premium, this option provides additional coverage with benefits to be paid if you die due to an accident (as defined in the rider). Coverage remains in effect until the policy anniversary date following your 65 th birthday. You can purchase amounts up to the face amount of the policy, to a maximum of $150,000. Policyholder must be under age 61 at the time of application. (Not available in Connecticut.)
H OW D O Y OU A PPLY?
One of our licensed life insurance professionals can complete an application with you over the phone. We will then mail, email or fax the application for your review. Call 1-800-234-5433 today to apply. Please note: The information presented herein describes our standard policy available in most states (policy form numbers ICC11 FGCLT02-01 and ICC11 CLT02-01). In this brochure we have tried to highlight the most significant state-specific differences. Please refer to the personalized illustration to review your state's specific policy features.
O PTIONAL B ENEFITS AND R IDERS

Several options are available with this policy, which enables you to design a plan that best meets your needs.
Waiver of Premium
This valuable benefit eliminates the additional financial burden of having to pay for life insurance at a time when you may be faced with huge medical expenses and lost income as a result of a disability. With this benefit, we will waive your policy premium and continue your coverage if you are disabled for six consecutive months. After the sixth month, we will refund to you all premiums paid from the original date of disability, and all future premiums due will be waived until you recover or your policy matures.
* Policy
title and some product features may be different in certain states.
L657-7
H OW M UCH L IFE I NSURANCE D O Y OU N EED T O P ROTECT Y OUR F AMILY?

This simple worksheet can give you an idea. Its only approximate, however. You should consult with an insurance agent or other financial advisor before buying any insurance products. The worksheet assumes you die today.
INCOME:
1 Total annual income your family would need if you died today:
What your family needs, before taxes, to maintain its current standard of living.
(Typically between 60% - 75% of total income)
2 Annual income your family would receive from other sources:

Dividends, interest income, spouses earning. (Social Security may be available)
3 Income to be replaced: Subtract line 2 from line 1. 4 Capital needed for income: Multiply line 3 by the appropriate factor in Table A. EXPENSES: 5 Funeral and other final expenses:
(Typically the greater of $15,090 or 4% of your estate)
6 Mortgage and other outstanding debts:
Include mortgage balance, credit card debt, car loans, etc.

(2004-2005 average 4-year costs: Private $118,602; Public $48,938*)
7 College costs for each child, in todays dollars:
8 Capital needed for college: Multiply line 7 by the appropriate factor in Table B. 9 Total capital required:
Add lines 4, 5, 6 and 8.
ASSETS: 10 Savings and investments:

Bank accounts, money market accounts, CDs, stocks, bonds, mutual funds, etc.
11 Retirement savings:
IRAs, 401(k)s, Keoghs, pension and profit sharing plans.
12 Present amount of life insurance:

Include group insurance as well as insurance purchased on your own.
13 Total income producing assets: 14 Life insurance needed:
Add lines 10, 11 and 12.
Subtract line 13 from line 9.
NUMBER OF YEARS INCOME NEEDED 10 15 20 25 30 35 40
FACTOR 8.1 11.1 13.6 15.6 17.3 18.7 20.0
NUMBER OF YEARS BEFORE C OLLEGE 5 10 15 20
F ACTOR .82 .68 .56 .46
Important note: Inflation is assumed to be 4%. The rate of return

on investments is assumed to be 8%
This worksheet was developed by the Life and Health Insurance Foundation for Education, a non-profit organization designed to address the publics growing need for information and education on life, health, and disability insurance. * Annual Survey of colleges: The College Board, 2005

PDF0 1

Hochgeladen von

Dokumentinformationen

Originalbeschreibung:

Originaltitel

Copyright

Verfügbare Formate

Dieses Dokument teilen

Dokument teilen oder einbetten

Freigabeoptionen

Stufen Sie dieses Dokument als nützlich ein?

Sind diese Inhalte unangemessen?

Copyright:

Verfügbare Formate

PDF0 1

Hochgeladen von

Copyright:

Verfügbare Formate

12/07/2011

DOCUMENTS TO PICK & SPECIAL HANDLING:

Jeffrey Laviana 203 Hudson St Berlin, CT 06037

Jeffrey Laviana 203 Hudson St Berlin, CT 06037

LIFE INSURANCE QUOTATION

PREMIUM GUARANTEE PERIOD *

MONTHLY CONTRACT PREMIUM

10 Year Level Term (with Cost-of-Living Benefit)

Age 55, Female; Preferred Rate

( ) Waiver of Premium Benefit ( x ) Children's Insurance Benefit: 10 unit(s)

Not included $3.96

TOTAL MONTHLY CONTRACT PREMIUM

ALTERNATE METHODS OF PAYMENT

ANNUAL SEMI-ANNUAL QUARTERLY

$398.50 $202.25 $102.63

Amica Life Insurance Company PO Box 6008 Providence, RI 02940-6008

LIFE INSURANCE QUOTATION

Not included $3.96

Guaranteed Death Benefit

Guaranteed * Maximum Premium

Prepared by: Cristina Simao December 07, 2011

Representing: Amica Life Insurance Company CT Version Page 1 of 2

LIFE INSURANCE QUOTATION

Guaranteed Death Benefit

Guaranteed * Maximum Premium

Prepared by: Cristina Simao December 07, 2011

Representing: Amica Life Insurance Company CT Version Page 2 of 2

LIFE INSURANCE QUOTATION

PREMIUM GUARANTEE PERIOD *

MONTHLY CONTRACT PREMIUM

10 Year Level Term (with Cost-of-Living Benefit)

Age 24, Female; Preferred Select Rate

) Waiver of Premium Benefit ) Children's Insurance Benefit: 10 unit(s)

Not included Not included

TOTAL MONTHLY CONTRACT PREMIUM

ALTERNATE METHODS OF PAYMENT

ANNUAL SEMI-ANNUAL QUARTERLY

$107.00 $56.50 $29.75

Amica Life Insurance Company PO Box 6008 Providence, RI 02940-6008

LIFE INSURANCE QUOTATION

PREMIUM GUARANTEE PERIOD *

MONTHLY CONTRACT PREMIUM

10 Year Level Term (with Cost-of-Living Benefit)

Age 18, Female; Standard Rate

) Waiver of Premium Benefit ) Children's Insurance Benefit: 10 unit(s)

Not included Not included

TOTAL MONTHLY CONTRACT PREMIUM

ALTERNATE METHODS OF PAYMENT

ANNUAL SEMI-ANNUAL QUARTERLY

$195.00 $100.50 $51.75

Amica Life Insurance Company PO Box 6008 Providence, RI 02940-6008

LIFE INSURANCE QUOTATION

PREMIUM GUARANTEE PERIOD *

MONTHLY CONTRACT PREMIUM

10 Year Level Term (with Cost-of-Living Benefit)

Age 20, Male; Preferred Rate

) Waiver of Premium Benefit ) Children's Insurance Benefit: 10 unit(s)

Not included Not included

TOTAL MONTHLY CONTRACT PREMIUM

ALTERNATE METHODS OF PAYMENT

ANNUAL SEMI-ANNUAL QUARTERLY

$143.00 $74.50 $38.75