West Coast Global InsuranceServices

The most cost effective Life Insurance available and can be purchased for a term of 10, 15, 20 & 30 years based on age. Term Insurance has an end date based on the term selected.

4.) Have you ever applied for life insurance in the past?:&/or do you have any life insurance active now?

4a.) Please provide how many active life insurance policies you have in place now?

5.) Do you currently participate in any private aviation activities (not including scheduled commercial flights)?

5a.) Please provide details of your private aviation activities?

8.) Have you had any history with drug or alcohol abuse?

8a.) If yes, when?

9.) Have you had any history of internal cancer, melanoma or heart disease?

9a.) If yes, provide details & when?

10.) Do you have diabetes?

10a.) If yes, is your diabetes gestational or late onset?

11.) How many medications are you taking?

12.) Do you participate in or have you participated in any hazardous sports or avocations within the last three years (i.e. hang gliding, ballooning, motorized racing, parachuting or scuba diving)?

12a.) If yes, provide details?

13.) Do you use any nicotine products?

14.) Have you ever used any nicotine products?

14a.) If you have quit, when did you quit?

15.) Have you had a dui and/or a reckless driving citation in the past 5 years)?

15a.) If yes when?

16.) Have you received a felony conviction in the past 10 years?

17.) Have you filed for bankruptcy in the last 5 years?

18.) Have any one of your natural parents or siblings had any history of or death from cancer, heart disease or cardiac related conditions?

18a.) Please provide age of onset and/or age at death of natural parent or sibling?