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Knowing the type and amount is a great start!
Answer a few questions and you are on your way
Sex
MALE
FEMALE
Date of Birth
Zip Code
Please enter your 5 digit zip code
Insurance Type
TERM
PERMANENT
Years of Coverage
Term 10
Term 20
Term 30
Amount of Coverage
$
The amount cannot have more than 7 digits
Please use a value between 100,000 and 3,000,000
Policy Riders
Waiver of Premium
Accidental Death Benefit
ˇ
Do you smoke?
YES
NO
How many Child Rider Units
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
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32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
What kind of tobacco?
Cigarettes
Cigars
Pipe
Chewing Tobacco
Nicotine Gum
Nicotine Patch
When was the last time?
Currently
Quit less than 1 year ago
Quit 1-2 years ago
Quit 2-3 years ago
Quit 3-4 years ago
Quit 4-5 years ago
Quit more than 5 years ago
Height
Cms
Inches
ft
in
m
cm
Weight
Kgs
Lbs
Kg
Lbs
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