Quote Or Apply

Each company has its own underwriting requirements.  This is a partial and incomplete list: all aspects of your personal and family health, lifestyle and financial needs play a part in the final underwriting decision.  To save time and avoid disappointment, please answer the following questions truthfully.

1.  Are you currently employed and have you actively and continuously participated in the duties of your regular occupation on a full time basis (at least 30 hours per week) for the past 6 months?  Yes No 
Place of Employment:

2.  If retired or currently unemployed, are you physically and mentally capable of being employed on an active, full time basis?
Yes No

3.  Have you been disabled for 30 days or longer during the previous 12 months and has said disability prevented you from performing your normal daily duties or activities, or are you currently receiving disability benefits? 
Yes No

4.  Have you in the past 5 years flown, or do you intend to fly, other than as a passenger? 
Yes  No

5.  Have you in the past 2 years engaged in, or do you expect to engage in, any hazardous activities or sports such as hang gliding, hot-air ballooning, ultra-light flying, mountain or rock climbing, motor vehicle or boat racing, or scuba or sky diving?
Yes  No

6.  Have you in the past 5 years traveled or resided, or do you intend to travel or reside, outside of the continental United States for more than 6 consecutive weeks?  
Yes  No

7.  Height Weight Any weight loss in the last 12 months?  
Yes  No

8.  Have you ever had or have you ever been told that you had: high blood pressure, chest pain, stroke, or disease of the heart or blood vessels; cancer or tumor of any kind; epilepsy, mental or nervous disorder;  diabetes; lung or respiratory disorder; gastric or intestinal disorder; kidney or urinary tract disorder; disorder of the blood or lymph nodes; or any disease of the reproductive organs?  
Yes  No    If yes:  please give full details:

9.  Have you been diagnosed or treated by a member of the medical profession as having AIDS, ARC, or the HIV infection?   
Yes  No

10.  Have you ever used heroin, cocaine (including crack), LSD, PCP, amphetamines, barbiturates, any derivative of these drugs, or any other controlled substance except as prescribed by physician?  
Yes  No

11.  Have you ever received or have you been advised to seek counseling for alcohol or drug abuse?  
Yes  No

12.  Are you currently taking or have you been advised to take any medication?  
Yes  No
If yes, please list names, dosages, and frequency taken:

13.  At any time during the past five years have you been hospitalized or have you consulted, been examined or treated by any other physician, psychiatrist, or medical practitioner not disclosed in response to the previous questions?  
Yes  No
If yes, please list all occurrences and provide name(s)/address(es), dates, and reasons:

14.  What is the purpose of your purchase:
Survivor Needs  Estate Planning  Mortgage Protection
Other (please fill in)

Some term life companies today will check your driving and credit record as part of their normal underwriting procedures in order to assess your overall lifestyle and risk characteristics.

As part of the normal underwriting process for every life insurance company, there may be one or more telephone interviews over the next 4 weeks regarding your health history, lifestyle habits, and financial situation.  All applicants should prepare to make themselves available for these interviews and to truthfully answer whatever questions are asked.

All life insurance companies today typically require a face-to-face interview between the applicant and a paramedic technician for amounts of life insurance which exceed $100,000.  Click here to read more about preparing for a paramed exam.