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FINAL EXPENSE LIFE INSURANCE   This Plan Available Only in CA, IL, TX, VA

WHY BUY Anthem Blue Cross FINAL EXPENSE LIFE INSURANCE

According to the National Funeral Directors Association, the average funeral costs $6,750

Social Security death benefit is $255 (if you qualify)

Our benefits are from $3,000 to $25,000

Our policies may be issued to individuals only between the ages of 45 and 80

4 medical questions, NO medical exam and NO waiting period required

Fill in this form to have your Brochure with Pricing & Application mailed to you.
Or call (877)566-5454 Toll Free

Customer Information
Full Name
E-mail
Street Address
City
State	-- Choose -- CA IL TX VA
Zip Code
Home Phone
Work Phone

Coverage Requested
Amount Requested	-- Choose Amount -- $3,000 $4,000 $5,000 $6,000 $7,000 $8,000 $9,000 $10,000 $11,000 $12,000 $13,000 $14,000 $15,000 $16,000 $17,000 $18,000 $19,000 $20,000 $21,000 $22,000 $23,000 $24,000 $25,000
People Covered	-- Please Select -- Me Only Me and Spouse
My Gender:	Male    Female
My Birthdate (Ages 45-80):	Month 1 2 3 4 5 6 7 8 9 10 11 12 Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928
How would you classify your health?	Excellent Good Fair Poor
Do you have any serious health problems?	Yes   No Please give explaination in box below
Spouse's Name:
Gender:	Male    Female
Spouse's Birthdate (Ages 45-80):	Month 1 2 3 4 5 6 7 8 9 10 11 12 Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928
How would you classify your spouse's health?	Excellent Good Fair Poor
Does spouse have any serious health problems?	Yes   No Please give explaination in box below

Have you any comments, questions or special instructions?

 

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Final Expense Life Insurance.PPS

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