Universal Life Insurance - Flexible Premium
For some people, Universal life insurance with flexible premium is what best meets their needs.
Another category, Universal with a fixed premium for the insured's lifetime, is like a "permanent term insurance" and is included in the online term insurance quoting.
No insurer that we know of has online quotes for the flexible premium category, so we will get them for you.
Reasons to have Universal Life with Flexible Premium:
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If you prefer not to use the form, call us at 1-800-722-9053 to give us the information over the telephone.
The more complete and accurate the information, the more realistic the quote can be.*Required
*First Name:
*Last Name:
*Street Address:
*City:
*State:
*Zip:
*Day Phone:
*Evening Phone:
Best time to call:
*Email Address:
*Repeat Email:
Birthdate:
Height:
Weight (pounds):
Yes No Treated for drug or alcohol abuse in the last 5 years?
Yes No Convicted of DUI or DWI in the last 5 years?
Yes No Ever used tobacco? Type: # years:
Date last used: Average quantity per day:
Yes No High blood pressure (hypertension)? State levels if known:
Systolic (top level): Diastolic (bottom level):
Yes No High cholesterol? Level and ratio:
All medications prescribed last 2 years – prescribed dosage & frequency – reason:
Last 10 years list all – medical conditions — treatment — approximate dates:
Last 10 years list all – mental conditions — treatment — approximate dates:
If a parent or sibling died before age 60 from sickness, state which, and cause:
Dangerous sports/hobbies (include private pilot) — approx. date of last activity:
Describe any recent or planned future travel outside North America:
Have you ever been declined for life insurance? If so, give reason:
Describe your occupation — any other comments:
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