Life Insurance Helpline
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Why are you looking for life insurance?
Protecting Family
Cover Burial Cost
Other
What is your annual income?
Less than $20,000
$20,000 - $34,999
$35,000 - $49,999
$50,000 - $74,999
$75,000 - $99,999
$100,000 - $149,999
$150,000 - $199,999
$200,000 or more
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Have you used Tobacco Products within the last 12 months?
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What is your credit rating?
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What is your height?
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Are you currently taking any prescription medications?
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Are you a homeowner?
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In the past 5 years have you been treated or prescribed medication for any of the following conditions?
Anxiety / depression / bipolar
Heart or circulatory disorder
Cancer
Respiratory disorder
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Other medical condition
Diabetes
I have no medical conditions
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