UHL/UFFL Premium Quoting
Whole Life:  GIWL - EIWL - EI Deluxe - EI Premier - Provider WL - All Whole Life -- Accidental Death  
Term:  Simple Term 20 - Simple Term 20 DLX - Simple Term 20 ROP - Simple Term 30 - All Term  
** FOR AGENT USE ONLY - NOT TO BE SHOWN TO OR PROVIDED TO CLIENTS **
** A quote is not a guarantee that any coverage will be issued. **
 
    State *  
All Term Products
Age (age at LAST birthday)
Birth Date * (mm/dd/yyyy)
Sex * Nicotine Use * Payment *
M   F Y   N
  Choose Face OR
   Premium (not both) * 		All Term Products
Simple Term 20 Simple Term 20 DLX Simple Term 20 ROP Simple Term 30
Req. Face Amt.  
Req. Premium  
 
Child Rider  
Accidental Death   NA
Waiver of Premium   Y N NA NA Y N
 
 
Quote Results
Face Amt =                  
Premium =                  
**Guaranteed Cash Value End Of Year 20 =                  
**RPU Face Amount End Of Year 20 =                  
Insurance Age =                  
 
( * = required information)