Refer A Case

The Growth Structured Settlement requires agency approval. Someone from Assura Trust will contact you about next steps.

Request an Illustration

Please Complete all fields for a comprehensive illustration

Claimant Information

Date of Birth [[ `(${calculatedAge} years old)` ]]

Settlement Amount Information

Growth Structured Settlement (GSS) Information

How should payments from the GSS be made?

GSS Periodic Payments

To begin on [[ `(${calculatedAge} years old)` ]]

Payable on [[ `(${calculatedAge} years old)` ]]

Annuity Information

Please provide annuity quote(s) with this request, to be incorporated into the total illustration in the attachment section below.

Trust Information (Optional)

Attachments

For Assura Trust to provide a full illustration, please attach an annuity quote. The annuity quote should be valid, up-to-date, and meet all life company underwriting rules. Attach any other documents that may be relevant to the illustration such as a Life Care Plan.

Valid formats include images, Microsoft documents, PDF, videos, audio files, etc.

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Assura Trust may not be able to provide a complete illustration if you do not fill out all required fields.

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