Who Qualifies

Are you the policy holder, or a family member?

Policy Holder (Self)Wife of Policy HolderHusband of Policy HolderChild of Policy HolderFriend of Policy Holder

What is your age or the age of the policy holder? If a survivorship policy, the age of the youngest insured. *

64 years or younger65-72 years73-87 years88 years or older

Gender of insured? If a survivorship policy, choose female.*

FemaleMale

Health of the insured? If a survivorship policy, answer for the youngest insured. *

Healthy and activeSlight medical issuesModerate medical issues (controllable)Major medical issuesNot sure

What type of policy do you own?*

Term LifeConvertible Term LifeSurvivorship Universal LifeSurvivorship Whole LifeWhole LifeUniversal LifeNot sure

What is the cash surrender value? *

10% of the death benefit or greater5%-10% of the death benefitUp to 5% of the death benefitNot Sure

What are the outstanding loans against the policy?

No loans against the policyUp to 50% of the death benefitGreater than 50% of the death benefitNot sure

What is the annual premium as a percentage of the death benefit?*

5% or greater4%3%Up to 2%Not sure

What is the death benefit?*

Up to $250,000$250,000 - $5 million$5 million or greater

Your Name (required)

Your Email (required)

Telephone

Additional Information