Request Login Information

This is a password protected website. Access to this website is restricted to persons meeting certain requirements imposed by the securities laws of the United States. The information requested in this Questionnaire is needed in order for the Global Life Plus to determine your eligibility to receive a password and gain access to this website.

Persons interested in receiving a password must complete the Questionnaires set forth below. The Global Life Plus reserves the right to deny any person access to this website at any time and for any reason.

The Global Life Plus may request from you such additional information as it may deem necessary to evaluate your eligibility to access this website and may request from time to time such information as it may deem necessary to determine your continued eligibility to access this website or to enable the Global Life Plus to determine its compliance with applicable laws and regulatory requirements. By submitting this Questionnaire you represent and warrant to the Global Life Plus that the information provided by you is true and correct.

We will be reviewing your submission as soon as possible.


First Name (required)

Last Name (required)

Company

Who You Are


Financial Planner/Advisor please select license(s) held

Series 7 Series 65 Series 22


Please certify yourself as one of the following:

I certify that I have an individual net worth, or my spouse and I have a combined net worth, in excess of U.S. $1,000,000. For purposes of this Questionnaire, "net worth" means the excess of total assets at fair market value including home , home furnishings and automobiles, over total liabilities.

I certify that I had individual income (exclusive of any income attributable to my spouse) of more than U.S. $200,000 in each of the past two years, or joint income with my spouse of more than $300,000 in each of those years, and I reasonably expect to reach the same income level in the current year.


Email (required)

Phone

Address

City

State

Zip

How did you hear about us?

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