Get Single Premium Life Insurance Quote

Premium Amount

You make one lump-sum payment known as "single-premium."

MINIMUM PREMIUM AMOUNT IS $10,000

Death Benefit

You determine your amount of coverage needed.

State

Gender

Tobacco Use

Yes No

Date Of Birth

Are you a citizen or permanent resident of the United States?

Yes No

Within the past 10 years, have you been diagnosed, treated, tested positive for, or been given medical advice by a member of the medical profession for any of the following?

Heart or coronary artery disease or disorder
Peripheral vascular disease
Hepatitis C
Disorder of the brain or nervous system
Alzheimer's disease
Emphysema
Lymphoma
Pancreas disease or disorder
Chronic lung or Pulmonary disease
Stroke

Diabetes treated with insulin
Parkinson's disease
Leukemia
Cirrhosis
Emphysema
Any disorder or disease of the immune system
Cancer (Other than basal or squamous skin cancer)

Yes No

Has the proposed insured ever been prescribed any of the following medications?

Blood Thinners
Insulin injections
Combivent or Spiriva
Plavix(Clopidogrel)

Diuretics
Any drug used in the treatment of Alzheimer's, cognitive impairment or dementia

Yes No

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