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 ROP  
** Simple Term 20 ROP: 20 - 60 MNT & FNT; 20 - 40 MT & FT **
 
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 ROP
Case 1 Case 2 Case 3
Req. Face Amount  
Req. Premium  
 
Child Rider  
 
Quote Results
Face Amount =              
Premium =              
**Guaranteed Cash Value End Of Year 20 =              
**RPU Face Amount End Of Year 20 =              
 
( * = required information)