realLIFEstories

The deadline to submit your long-term care insurance story has ended. Please note we will begin to accept applications for our 2012 realLIFEstories Client Service Awards Program starting November 1, 2011. We encourage you to submit your LTCi story at that time at www.lifehappens.org/reallife

In response to the growing need to educate the public about the importance of long-term care insurance, the LIFE Foundation is seeking LTCI client success stories from producers who specialize in this important planning area. LIFE plans to incorporate the stories it collects in its public education efforts. Some may be turned into realLIFEstories print pieces or videos. Others might be featured in magazine articles, on LIFE’s website, or in community seminars. In exchange for sharing your client’s story, LIFE will give you a $20 credit (shipping and handling included) toward the cost of your next purchase of LIFE marketing materials. So thanks in advance for contributing to our educational efforts. We couldn’t do what we do without you!

Important note: This special solicitation of LTCI realLIFEstories is not part of the official realLIFEstories Client Service Awards Program. Stories submitted for this special initiative may also be submitted for the official realLIFEstories program. Solicitation of stories for the 2012 realLIFEstories program will begin several months from now.

Deadline: Please submit your LTCI story by no later than September 23, 2011.

	ABOUT YOU
	Name* First Name Last Name
	Title
	Agency Name*
	Address* City State Zip Code
	Email*
	Telephone*
	Cell*	Fax
	Primary Company*	State(s) in Which Licensed*
	How many years have you been in insurance sales?*
	Professional Designation(s), please select all that apply: CASL CFP ChFC CLU CPCU FLMI FSS HIA LUTCF REBC RHU CLTC Other: Other Value
	Are you a member of a professional insurance agent or financial planning association(s)?
	If yes, please check all that apply AALTCI AALU Forum400 FPA GAMA Intl. IIABA MDRT NAHU NAIBLA NAIFA PIA SFSP Other: Other Value

	YOUR CLIENT’S STORY
	1. To protect the client’s privacy, please provide only first name, city and state.
	Client’s first name*
	City*
	State*
	Please indicate your client’s race / ethnicity (optional) African American / Black Asian American Asian / Indian Subcontinent Hispanic / Latino / Mexican American Native American / Alaskan Native Native Hawaiian / Pacific Islander White / Caucasian Other: Other Value
	2. What were the Activities of Daily Living (ADL’s) that triggered your client’s need for the claim? (check all that apply) Continence Dressing Toileting Eating Bathing Transference Other: Other Value
	3. Year that a claim was first paid your client’s LTCI policy*
	4. How old was your client when he/she purchased the policy?* 39 or younger 40 – 45 46 – 49 50 – 54 55 – 59 60 – 64 65 – 69 70 or older
	5. From which company was the long-term care policy that benefited your client purchased?*
	6. How long was the policy that benefited your client in effect prior to a claim being paid?* (Years)
	7. What age was your client when the first claim was paid?*
	8. Please indicate the long-term care setting where your client has received. (Check all that apply)* Home health care Assisted living facility Nursing home Adult day care Other: Other Value
	9. Has the LTCI policy help preserve retirement savings for the claimant and/or his/her spouse?* Yes No
	10. What type of policy benefited your client?* Individual policy Group policy through an employer sponsor Association sponsored policy
	11. Has this story ever appeared in a national consumer publication?* Yes No
	12. I certify that all information submitted is accurate to the best of my knowledge and is being made with my client’s understanding and consent.* I agree
	Essay Description: Please attach an essay of no more than 600 words describing your client’s long-term care insurance realLIFEstory. Be sure to describe what made your client decide to obtain the coverage, what happened to trigger the need for covered services, and what types of LTC services your client has received. Some of the stories LIFE collects may be turned into realLIFEstories print pieces or videos. Others might be featured in magazine articles, on LIFE’s website, or in community seminars. In exchange for sharing your client’s story, LIFE will give you a $20 credit (shipping and handling included) toward the cost of your next purchase of LIFE marketing materials. So thanks in advance for contributing to our public education efforts.
	Essay*

realLIFEstories

Solicitation of Long-Term Care Insurance Stories

ABOUT YOU

YOUR CLIENT’S STORY

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