Blood Pressure impaired risk underwriting
             
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License #'s: for Lewis Fink, CA: OC38446 MT: 29724 F00-0283-LC 

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Blood Pressure

Obtain a tentative life insurance offer for an impaired underwriting risk that involves Blood Pressure by completing the form below:

* required information

**Please use TAB key to proceed to the next question field, not the ENTER key.**
Applicant's Name*:
Applicant's Address*:
Applicant's Phone Number*:
Applicant's E-Mail Address*:
Date Of Birth:
Sex: Male Female
Height:
Weight:
Occupation:
Death Benefit:
Type of Product: Term Universal Whole Life
Second to Die Variable
Have you ever used tobacco or nicotine products? Yes No
If yes, what type of product did you use? (Select all that apply)
Cigarettes Cigar Pipe Other
2. When diagnosed?
3. Type of treatment? Diet: Weight Loss:
 Salt Reduction: Medication:
If applicable, list medications:
Do you take medications regularly? Yes No
4. Is your blood pressure controlled currently? Yes No
Last reading?
5. Any complications?
6. Has an electrogram been done? Yes No
7. Additional Comments?

Declined from other Life Insurance Companies

Do you Have A Medical Condition For An Impaired Risk
or Participate In A Hazardous Hobby?

Click on the topic below to complete an impairment questionnaire.
We will respond within 72 hours.

Have questions... Send an e-mail to the "Doc"

4 Application underwriting your life insurance policies

 4 Determine your underwriting classification

 4 Decision chart could help you decide the type of life insurance to purchase

TermLifeAmerica.com- Lewis Fink is licensed as an insurance agent offering Life Insurance in the following states: Alabama - AL, Arkansas - AR, California - CA, Colorado - CO, Connecticut - CT, Delaware - DE, District of Columbia - DC, Florida - FL, Georgia - GA, Idaho - ID, Illinois - IL, Indiana - IN, Iowa - IA, Kansas - KS, Kentucky - KY, Louisiana - LA, Maine - ME, Maryland - MD, Massachusetts - MA, Michigan - MI, Mississippi - MS, Missouri - MO, Montana - MT, Nebraska - NE, New Mexico - NM, New Jersey - NJ, New York - NY, North Carolina - NC, North Dakota - ND, Ohio - OH, Oklahoma - OK, Pennsylvania - PA, Rhode Island - RI, South Carolina - SC, South Dakota - SD, Tennessee - TN, Texas - TX, Utah - UT, Vermont - VT, Virginia - VA, and Wisconsin - WI.  

 Not all insurance products from all insurance companies are available in all states.

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                                             Blood Pressure impaired risk underwriting