Final Expense (California only)

 Are you prepared for Final Expenses?

According to the US Senate Committee on aging, the average cost of a funeral is approximately $8,495

This total may include such expenses as:  

To receive a quick quote please answers a few question:

Date of Birth

Gender   Place of Birth

Height ft in  Weight lbs

Tobacco/Nicotine Use

First Name

Last Name

Full Address (California only)

Day Phone Evening Phone

E-mail

To receive a quick quote please answers a few question:

 Are you United State citizen or do you have Permanent Resident Status (a Green Card)?   

Occupation & Employer Annual Income: $

2. Have you been diagnosed as having or been treated by a member of the medical profession for:

a.     Acquired Immune Deficiency Syndrome (AIDS) or AIDS Related Complex (ARC)? 

b.   Alzheimer’s disease (dementia), Amyotrophic Lateral Sclerosis (ALS), mental retardation or Downs Syndrome or do you require the assistance of another person for dressing, bathing, toileting, or mobility or do you use an oxygen tank?? 

3. Have you, within the past 2 (two) years:

a.   had a heart attack myocardial infarction) or stroke (cerebral vascular accident)? 

b. had or are now awaiting an organ or bone marrow transplant (except as a donor)?

c. received or been prescribed radiation or chemo therapy or have you received or been prescribed dialysis?

d. been confined to a nursing home, hospice, extended care or special treatment facility or are you now hospitalized?

e used controlled substances such as cocaine, heroin, amphetamines, barbiturates or hallucinogens except as prescribed by a physician or been treated for or been advised by a physician to seek treatment for drug or alcohol use?

f. been advised by a physician that your life expectancy is less than 24 months?

g. had more than one DUI (DWI) violation, been convicted of a felony or are you now on probation?

4. Do you have any other life insurance or annuity now in force? (If Yes, describe in Details section)

5. Will the issuance of this policy result in the replacement, lapse or termination of any other life insurance or annuity? (If Yes, complete and submit the appropriate State Replacement forms.)

Details of yes answers