REQUEST FOR LIFE INSURANCE QUOTELife Insurance Name* 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
