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Ensure your loved ones with a successful financial future.
Give
yourself
and
them
PEACE OF MIND.
See if You Qualify for
Easy and Affordable Life Insurance
in Just 30-Seconds!
Complete this quiz so we can determine your eligibility.
Gender
Male
Female
Age
18 - 29
30 - 34
35 - 39
40 - 44
45 - 49
50 - 54
55 - 59
60 or Older
Are you unable to work or perform normal activities due to a chronic illness or permanent injury?
YES
NO
Have you, within the past 5 YEARS, been treated for or diagnosed by a medical professional with any of the following:
HIV, AIDS or AIDS-related Complex, Diabetes requiring Insulin, Alcohol or Drug Abuse, Chronic Depression, Cancer (except basal cell), Stroke, Chronic Liver Disease, Mental Disorder, Heart Disease, Chronic Disorder of the Brain or Spinal Nerve, Chronic Kidney Disease, Chronic Lung Condition
YES
NO
If you answered YES to Q4, please check all that apply.
HIV, AIDS or AIDS-Related Complex
Diabetes Requiring Insulin
Alcohol or Drug Abuse
Chronic Depression
Cancer (except basal cell)
Stroke
Chronic Liver Disease
Mental Disorder
Heart Disease/Condition (except high blood pressure)
Chronic Disorder of Brain or Spinal Nerve
Chronic Kidney Disease
Chronic Lung Condition
Tobacco Usage
Everyday
Once a week
2 to 3 times a month
Never
How much policy coverage do you think you'll need?
Less than $50,000
$50,000 - $100,000
$100,000 - $250,000
$250,000 - $500,000
$500,000 - $1,000,000 or more
Not Sure
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