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Section A — Life

Section A - Life: Yes to question 1 (prior Declines) will be considered on a case-by-case basis after review of the prior coverage. Many of these will still be Declines. Yes to question 2 will cause the application to be issued at tobacco rates. Yes to questions 3-5 will cause the life application to be declined.

Section B — Accident

Section B - Accident: Yes to any questions in Section B will cause the A71 application to be issued with a rider. REMINDER: If the Senior Life product is declined, the A71 will also be declined.

Section C — Cancer

Section C - Cancer: Yes to the question in Section C will cause the Cancer application to be declined.

    🚨 All medications are to be listed on the app under the “Remarks or Instructions” section 🚨