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Applicant Information

Applicant Information

Applicant Information

Applicant Information

Please add in the missing details

I'll need some basic info about you

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Do you have any life insurance or annuities currently in force or pending?

Do you have any COVID 19 in last 30 days

Do you have any loose weight more than 10 pound in last 6 month?

Are you currently admitted to a

In the past 12 months, have you used

Have you ever tested positive for HIV?

In the past 12 months, have you received disability payments?

In the past 12 months, has a medical professional advised you to have

In the past 10 years, have you been diagnosed or treated by a medical professional for

Have you had a biological parent die before age 60 from any of the following

In the past 12 months have you been

Are you a U.S. Citizen?

Where were you born?

  • Afghanistan
  • Albania
  • Algeria
  • American Samoa
  • Andorra
  • Angola
  • Anguilla
  • Antarctica
  • Antigua and Barbuda
  • Argentina
  • Armenia
  • Aruba
  • Australia
  • Austria
  • Azerbaijan
  • Bahamas
  • Bahrain
  • Bangladesh
  • Barbados
  • Belarus
  • Belgium
  • Belize
  • Benin
  • Bermuda
  • Bhutan
  • Bolivia
  • Bosnia and Herzegovina
  • Botswana
  • Bouvet Island
  • Brazil
  • British Indian Ocean Territory
  • Brunei
  • Bulgaria
  • Burkina Faso
  • Burundi
  • Cambodia
  • Cameroon
  • Canada
  • Cape Verde
  • Cayman Islands
  • Central African Republic
  • Chad
  • Chile
  • China
  • Christmas Island
  • Cocos (Keeling) Islands
  • Colombia
  • Comoros
  • Congo
  • Congo, The Democratic Republic of the
  • Cook Islands
  • Costa Rica
  • Côte d’Ivoire
  • Croatia
  • Cuba
  • Cyprus
  • Czech Republic
  • Denmark
  • Djibouti
  • Dominica
  • Dominican Republic
  • East Timor
  • Ecuador
  • Egypt
  • El Salvador
  • Equatorial Guinea
  • Eritrea
  • Estonia
  • Ethiopia
  • Falkland Islands
  • Faroe Islands
  • Fiji Islands
  • Finland
  • France
  • French Guiana
  • French Polynesia
  • French Southern territories
  • Gabon
  • Gambia
  • Georgia
  • Germany
  • Ghana
  • Gibraltar
  • Greece
  • Greenland
  • Grenada
  • Guadeloupe
  • Guam
  • Guatemala
  • Guinea
  • Guinea-Bissau
  • Guyana
  • Haiti
  • Heard Island and McDonald Islands
  • Holy See (Vatican City State)
  • Honduras
  • Hong Kong
  • Hungary
  • Iceland
  • India
  • Indonesia
  • Iran
  • Iraq
  • Ireland
  • Israel
  • Italy
  • Jamaica
  • Japan
  • Jordan
  • Kazakstan
  • Kenya
  • Kiribati
  • Kuwait
  • Kyrgyzstan
  • Laos
  • Latvia
  • Lebanon
  • Lesotho
  • Liberia
  • Libyan Arab Jamahiriya
  • Liechtenstein
  • Lithuania
  • Luxembourg
  • Macao
  • Macedonia
  • Madagascar
  • Malawi
  • Malaysia
  • Maldives
  • Mali
  • Malta
  • Marshall Islands
  • Martinique
  • Mauritania
  • Mauritius
  • Mayotte
  • Mexico
  • Micronesia, Federated States of
  • Moldova
  • Monaco
  • Mongolia
  • Montserrat
  • Morocco
  • Mozambique
  • Myanmar
  • Namibia
  • Nauru
  • Nepal
  • Netherlands
  • Netherlands Antilles
  • New Caledonia
  • New Zealand
  • Nicaragua
  • Niger
  • Nigeria
  • Niue
  • Norfolk Island
  • North Korea
  • Northern Mariana Islands
  • Norway
  • Oman
  • Pakistan
  • Palau
  • Palestine
  • Panama
  • Papua New Guinea
  • Paraguay
  • Peru
  • Philippines
  • Pitcairn
  • Poland
  • Portugal
  • Puerto Rico
  • Qatar
  • Réunion
  • Romania
  • Russian Federation
  • Rwanda
  • Saint Helena
  • Saint Kitts and Nevis
  • Saint Lucia
  • Saint Pierre and Miquelon
  • Saint Vincent and the Grenadines
  • Samoa
  • San Marino
  • Sao Tome and Principe
  • Saudi Arabia
  • Senegal
  • Seychelles
  • Sierra Leone
  • Singapore
  • Slovakia
  • Slovenia
  • Solomon Islands
  • Somalia
  • South Africa
  • South Georgia and the South Sandwich Islands
  • South Korea
  • Spain
  • Sri Lanka
  • Sudan
  • Suriname
  • Svalbard and Jan Mayen
  • Swaziland
  • Sweden
  • Switzerland
  • Syria
  • Taiwan
  • Tajikistan
  • Tanzania
  • Thailand
  • Togo
  • Tokelau
  • Tonga
  • Trinidad and Tobago
  • Tunisia
  • Turkey
  • Turkmenistan
  • Turks and Caicos Islands
  • Tuvalu
  • Uganda
  • Ukraine
  • United Arab Emirates
  • United Kingdom
  • United States
  • United States Minor Outlying Islands
  • Uruguay
  • Uzbekistan
  • Vanuatu
  • Venezuela
  • Vietnam
  • Virgin Islands, British
  • Virgin Islands, U.S.
  • Wallis and Futuna
  • Western Sahara
  • Yemen
  • Yugoslavia
  • Zambia
  • Zimbabwe

What's your employment status?

I'll need some info about your finances

In the next 2 years, do you plan to

In the past 2 years have you been declined for life insurance?

In the past 10 years, have you been convicted, pleaded guilty to or have charges pending for a

How many alcoholic drinks do you typically have per week?

  • I don't drink
  • 1 drink
  • 2 drinks
  • 3 drinks
  • 4 drinks
  • 5 drinks
  • 6 drinks
  • 7 drinks
  • 8 drinks
  • 9 drinks
  • 10 drinks
  • 11 drinks
  • 12 drinks
  • 13 drinks
  • 14 drinks
  • 15 drinks
  • 16 drinks
  • 17 drinks
  • 18 drinks
  • 19 drinks
  • 20 drinks
  • 21 drinks
  • 22 drinks
  • 23 drinks
  • 24 drinks
  • 25 drinks
  • 26 drinks
  • 27 drinks
  • 28 drinks
  • 29 drinks
  • 30 drinks

In the past 10 years, have you used

Cocaine, methamphetamines, heroin, opioids, hallucinogens or any controlled substance not prescribed to you by a physician?

In the past 12 months, have you used any form of marijuana?

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We are Find A Plan, a company dedicated to providing quality insurance policies and consultation for all types of needs. Whether you need medical insurance, pet coverage, or life insurance, we have partner professionals to help you out. We pride ourselves on our customer service and making sure that everyone who comes to us walks away with the right policy for their needs. Contact us today to get started!

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