Graded Benefits Life Insurance
Ages 39½ to 80½

  • NO medical questions
  • NO medical examinations
  • NO medical tests

Has your health history made it difficult or impossible for you to obtain life insurance? We can help! Our Graded Benefit whole life insurance policy can provide your family with up to $50,000 of tax-free proceeds just when they will need it most. YOU CAN'T BE TURNED DOWN! There are NO medical questions, NO medical examinations and NO medical tests. Death benefits are limited during the first two or three years of the policy, but are 100% after that. 

Part A: Basic Quote Information
State:
Date of Birth:
Gender:
Height: ft.
Weight:
Coverage Amount:

 

Part B: Pre-screening Health Questionaire
Do you smoke or use tobacco?:
Are you currently residing in a hospital
or long-term-care facility?
Do you have AIDS or HIV?
Have you been declared terminally ill,
defined as having less than 24 months
to live?

 

Part C: Personal Information (not required)
First Name:
Last Name:
Home Phone: () -
Secondary Phone: () -
Email:

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