| A. | Do you currently receive kidney dialysis or require oxygen use or have you been diagnosed as having a terminal illness? (Terminal illness is defined as any illness diagnosed that would reasonably be expected to cause death within 24 months.) | o Yes |
o No |
| B. | Do you require assistance to eat, bathe, dress or take your own medication or are you currently confined to a hospital, nursing home, mental facility or hospice or have you been hospitalized two or more times in the past twelve months? | o Yes |
o No |
| C. | Have you ever tested positive for the AIDS virus or been diagnosed or treated, or recommend treatment for AIDS, ARC, or any other immune disorder? | o Yes |
o No |
Any question answered "Yes" in this section will disqualify the applicant for the Express Issue Whole Life Policy.
Remember, we guarantee up to $50,000 and cover 97.5% of all declines, not to mention the fact that you'll earn 105% commission. Cover your tough-to-place cases, contact us today for a quote.
Call Tennessee Brokerage Agency at 800.624.4502 or
fill out the form to the right for more information.
