REQUEST FOR INDIVIDUAL INSURANCE QUOTEHealthLife InsurancePension and AnnuityHealthHealth Insurance Name* First Last Date of Birth* DD slash MM slash YYYY Email* Contact Number*Gender*MaleFemaleAre you a smoker* Yes NoType of Policy1. Caricare Protector* a) CariCare Premium ($250,000.00 Lifetime Maximum) b) CariCare Gold ($500,000.00 Lifetime Maximum) c) CariCare Platinum ($1,000,000.00 Lifetime Maximum)2. Global Care Series* a) Global Care Premium ($250,000.00 Lifetime Maximum) b) Global Care Gold ($500,000.00 Lifetime Maximum) c) Global Care Platinum ($1,000,000.00 Lifetime Maximum)Deductible*$0.00$500.00$750.00$1,000.00$2,000.00Desirable Premium* Monthly Annually Single Pay Life InsuranceLife InsuranceName* First Last Date of Birth* DD slash MM slash YYYY Gender*MaleFemaleAre you a smoker?*YesNoType of PolicyTraditional Life:* Whole Life LPU to age 65Term:* 5 years Renewable 20 years RenewableAges* 65 years old 70 years old 80 years oldEndowment at age 65*YesNoPeace AssuredPayment Duration* 10 years 80 years 100 yearsFace Amount*N.B Minimum 25,000.00 and Maximum $60,000.00Benefits* Accidental Death Dismemberment Premium Waiver RepatriationDesired Premium* Monthly Annually Single Pay Pension and AnnuityPension and AnnuityName* First Last Date of Birth* DD slash MM slash YYYY Email* Contact Number*Gender*MaleFemaleAre you a smoker?* Yes NoType of Annuity/Pension* Immediate Deferred* Registered Non-RegisteredMaturity Age* 60 65 70 OtherPremium Wavier Benefits* Yes NoDesired Premium $* Monthly Annually Single Pay
