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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 *  
  Simple Term 20  
 
Age * (age at birthday)
Birth Date (mm/dd/yyyy)
Sex * Nicotine Use * Payment *
M   F Y   N
 
Choose Face OR   
      Premium (not both) *
Simple Term 20
Case 1 Case 2 Case 3
Req. Face Amount  
Req. Premium  
 
Child Rider  
Accidental Death  
Waiver of Premium   Y N Y N Y N
 
Quote Results
Face Amount =              
Premium =              
 
( * = required information)