Impaired Risk Underwriting For Race Car Driver

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   Impaired Risk Conditions For A
Race Car Driver Requires Additional Underwriting Information

Race Car Driver                

To obtain a tentative life insurance offer complete 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
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)
Cigar Pipe Other
2. Do you hold a competition license?   Yes No
What racing schools have you attended?  
Are you a professional or amateur racer?   Professional Amateur
3. What racing divisions do you participate in and who is the sanctioning body?  
How often and where do you race?  
4. Please describe the car used: displacement, maximum HP, chassis and maximum speed:  
5. Do you intend to race in any other classes/divisions?   Yes No
6. Additional Comments?  




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License #'s: for InsuranceQuotes-America are issued to Lewis Fink, CA: OC38446 MT: 29724 F00-0283-LC), and a major
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  Depending on
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The quotes generated by this program are not a contract, binder, or agreement to extend coverage and are based on the listed factors and the applicable underwriting criteria for the rate shown. The exact premium can only be determined after an underwriting review and may be different or the policy may not be available. Your information is only shared with the  company underwriter and never distributed in any other way.  All health insurance definitions defined here are to be understood
as being general definitions.  These definition may vary by insurance company and may be found in the
company policy or certificate of insurance. Not all products from all companies are available in all states. 


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Life Insurance Companies

Our spreadsheet quoting system allows for quick price comparisons!


■   American General Life Companies 
■   Assurity
■   Banner
■   Fidelity Life
■   Genworth
■   ING

  ■   John Hancock
Liberty Life
■   Lincoln National
■   Life Invertors

■   Met Life
■   North American
■   Old Mutual

Security Mutual  
■   Transamerica
Union Central
West Coast
Western Reserve Life
William Penn

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License numbers: for Lewis Fink agent, CA: OC38446 MT: 29724 F00-0283-LC 
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Not all products from all companies are available in all states.

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