Settlement Protection Questionnaire

Plaintiff-Only Settlement Planning Since 2003. | 888-674-0127

Attorney's Name(Required)

Attorney's Law Firm(Required)

First Name(Required)

Last Name(Required)

Gender

Date of Birth(Required)

Street Address(Required)

Street Address 2

City(Required)

State(Required)

Zip Code(Required)

Preferred Phone

Alternate Phone

Are you receiving any benefits or government entitlements? Please note all that apply.

Medicare

Medicaid

Supplemental Security Income

Social Security Disability

SNAP, WIC, Housing Voucher

Other

Total Settlement Amount

Net Settlement Amount to Plaintiff

Future treatment?

Is future treatment of injuries recommended?

Settlement Planning Options

Lump Sum Cash Payout

Receiving your settlement amount as a lump sum cash payout can be an effective way to payoff any debts such as a mortgage, credit card ormedical bills, or loans. This cash payment can also pay for any immediate needs such as home or vehicle modifications.

Structured Settlement Annuity

Structured annuities offer tax-exempt, fixed and determinable payments which do not fluctuate with market conditions. Structured annuity payout dates are selected by you and offer a return on the initial investment over the selected payout term.

Trust and/or Asset Protection Portfolio

A trust can help make certain that you maintain the same level of Medicaid or other benefit after settlement. In other instances, our advisors can build a managed portfolio that will meet your needs and goals and offer diversification of assets and settlement award.

Settlement Protection Planning Session with a Combination of the Above Options

Determining the right allocation of your settlement funds can be an overwhelming process to work through on your own. A well-rounded settlement plan balances a payment of upfront cash with the above referenced investment options, allowing your immediate needs to be met, and preserving your settlement proceeds for the next chapter in your life. Our advisors will work closely with you to lean about your unique goals and needs, and build a financial plan that will help you achieve these goals, while getting the most out of your settlement.

Amount of Lump Sum Cash Payout

Amount in Structured Settlement Annuity

Amount in Trust or Asset Protection Portfolio

Today's Date

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