Protectors Pass Form V2

 

1
About you
2
Your role
3
Areas of Focus
4
Verification & licensing
5
Your organization
6
Protectors Pass Plus
7
Life Insurance
8
Annuities
9
Client Focus / Investments
10
Financial Planning
11
P&C
12
Employee/Group Benefits
13
ACA/Medicare
14
Confirm
15
Last Page

About you

First Name *
Last Name *
Email *
Company *
Job Title *
Website URL *
Physical Address (for GDPR compliance) *

Your role

Which of the following best describes your role in the industry? *
Please specify. *

Areas of Focus

Which of the following are your areas of focus today, i.e., at least 10% of your business? Select all that apply. *
Please specify.

Verification & licensing

Please provide your NPN. *
Do you also have a CRD? *
Please provide your CRD. *
Years as a Licensed Agent
Primary States (select up to 10 or nationwide) *
Please provide your personal NPN. *
Required for production verification.
Please provide your agency's NPN. *
Required for production verification.
Do you also have a CRD? *
Please provide your CRD. *
Years as a Licensed Agent
Primary States (select up to 10 or nationwide) *
Please provide your CRD. *
Do you also have an NPN? *
Please provide your NPN. *
Primary States (select up to 10 or nationwide) *
Years as a Licensed Advisor
Please provide your CRD. *
Do you also have an NPN? *
Please provide your NPN. *
Years as a Licensed Advisor
Primary States (select up to 10 or nationwide) *
Please provide your NPN. *
Do you also have a CRD? *
Please provide your CRD. *
Years as a Licensed Agent
Primary States (select up to 10 or nationwide) *
Do you hold any industry licenses (NPN, CRD, Series 6/7/63, etc.)?
NPN (if applicable).
CRD (if applicable).
Years Licensed
Primary States (select up to 10 or nationwide) *

Your organization

Approximately how many producers or advisors are part of your organization? *
Approximately how many agents and/or advisors does your organization actively support? *
Which best describes your role? *
Approximately how many agents or advisors do you support? *
Which advisor channels do you primarily support? Select all that apply.
Please specify.
How would you best describe your engagement model with producers?

Protectors Pass Plus

Are you interested in also applying for Protectors Pass Plus to receive a Travel Reimbursement (up to $750)? *

The amount of travel reimbursement is determined by Protectors and based on potential fit with our Sponsors and on the number of qualifying meetings taken during Protectors. You can earn up to $750 in travel reimbursement - paid directly to you within 30 days after the show. More information can be found on the FAQ section of the Protectors Pass Page.

Life Insurance

Which life insurance products are most central to your practice? Select all that apply. *
Please specify.
Please indicate your approximate annual life insurance production. *
Please use annualized new premium or first-year placed premium for the most recent 12-month period. (Best estimate is fine.)
Which life insurance products are most central to your firm? Select all that apply. *
Please specify.
Please indicate your firm's approximate annual life insurance production. *
Please use annualized new premium or first-year placed premium for the most recent 12-month period. (Best estimate is fine.)
Which life insurance products are most central to what you support? Select all that apply. *
Please specify.
Approximately how much annual life insurance production do you influence or support across your territory? *
(Best estimate is fine.)
Which life insurance products are most central to your organization? Select all that apply. *
Please specify.
What is your organization's approximate annual life insurance production? *
Please estimate using placed premium. (Best estimate is fine.)

Annuities

Which annuity products are most central to your practice? Select all that apply. *
Please specify.
What was your approximate annual annuity production over the past 12 months? *
Please estimate using placed annuity premium. (Best estimate is fine.)
Which annuity products are most central to your firm? Select all that apply. *
Please specify.
What was your organization's approximate annuity production over the past 12 months? *
Total annual premium across all producers. (Best estimate is fine.)
Which annuity products are most central to what you support? Select all that apply. *
Please specify.
Approximately how much annuity production do you influence annually? *
Business you directly support or impact. (Best estimate is fine.)
Which annuity products are most central to your organization? Select all that apply. *
Please specify.
What is the approximate annual annuity production across your network? *
Total premium across your network. (Best estimate is fine.)

Client Focus / Investments

What type of households do you typically serve? Select all that apply. *
Please specify.
Which investment / wealth solutions are most central to your practice? Select all that apply. *
Please specify.
What is your approximate client AUM (assets under management or advised)? *
(Best estimate is fine.)
How do you serve investment-related client needs? Select all that apply.
Please specify.
What type of households does your firm typically serve? Select all that apply. *
Please specify.
Which investment / wealth solutions are most central to your firm? Select all that apply. *
Please specify.
Approximately how much client AUM does your firm advise on or manage? *
(Best estimate is fine.)
Which investment / wealth solutions are most central to what you support? Select all that apply. *
Please specify.
Which investment / wealth solutions are most central to your organization? Select all that apply. *
Please specify.
Approximately how much client AUM is associated with your organization's advisory / wealth platform? *
(Best estimate is fine.)

Financial Planning

Which best describes your primary business model? *
Please specify.
Approximately how many client households do you serve? *
(Best estimate is fine.)
What is your approximate annual planning-related revenue?
(Best estimate is fine.)
Which best describes your firm's primary business model? *
Please specify.
Approximately how many client households does your firm serve? *
(Best estimate is fine.)
What is your firm's approximate annual planning-related revenue?
(Best estimate is fine.)
Which planning models are most central to what you support? Select all that apply.
Please specify.

P&C

Which best describes your primary P&C focus? Select all that apply. *
Please specify.
What is your approximate total P&C book of business? *
Please estimate using annual written premium. (Best estimate is fine.)
Do you currently offer or refer clients for life insurance, annuities, or retirement planning?
Which best describes your firm's primary P&C focus? Select all that apply. *
Please specify.
What is your firm's approximate total P&C book of business? *
Please estimate using annual written premium. (Best estimate is fine.)
Does your firm currently offer or refer clients for life insurance, annuities, or retirement planning?
Which P&C lines are most central to what you support? Select all that apply.
Please specify.

Employee/Group Benefits

Which group benefits products are most central to your practice today? Select all that apply. *
Please specify.
What size employers do you primarily serve? Select all that apply. *
Approximately how many employer groups do you serve? *
(Best estimate is fine.)
Do you currently support employers or employees with broader financial protection solutions beyond core benefits?
Please specify.
Which broader financial protection solutions are or would be relevant to your practice? Select all that apply.
Please specify.
Which group benefits products are most central to your firm today? Select all that apply. *
Please specify.
What size employers does your firm primarily serve? Select all that apply. *
Approximately how many employer groups does your firm serve? *
(Best estimate is fine.)
Does your firm currently support employers or employees with broader financial protection solutions beyond core benefits?
Please specify.
Which broader financial protection solutions are or would be relevant to your firm? Select all that apply.
Please specify.
Which group benefits products are most central to what you support? Select all that apply.
Please specify.

ACA/Medicare

Which health insurance products are most central to your practice? Select all that apply. *
Please specify.
What was your approximate Medicare / health insurance production over the past 12 months? *
(Best estimate is fine.)
Which health insurance products are most central to your firm? Select all that apply. *
Please specify.
What was your agency's approximate Medicare / health insurance production over the past 12 months? *
Include all producers within your organization. (Best estimate is fine.)
Which health insurance products are most central to your organization? Select all that apply. *
Please specify.
Approximately how many Medicare / health clients / policies are written annually across your network? *
(Best estimate is fine.)
Which ACA/Medicare products are most central to what you support? Select all that apply.
Please specify.

Confirm

I'm interested in learning about bringing my team
Approximate Team Size
I understand that participation will require attendance at sponsored sessions, sponsored roundtables, and/or visiting with select sponsors. *
Which industry events have you attended or plan to attend this year?
If you have any comments and/or questions, please share them here.
Lastly, if you were referred by someone, please share below.
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