Proposed Policy Information
Age
Gender
Height Feet / Inches
/Weight
Tobacco
Family History (100 character max)
Face Amount
Insured Information (Limit 5)
Type of Concern
Diagnosis (50 character max)
Age at Onset
Treatment (50 character max)
Path Report: Microscopic Description (Cancer only)
Other Information (Limit 700 characters)
Type of Concern
Diagnosis (50 character max)
Age at Onset
Treatment (50 character max)
Path Report: Microscopic Description (Cancer only)
Other Information (Limit 700 characters)
Type of Concern
Diagnosis (50 character max)
Age at Onset
Treatment (50 character max)
Path Report: Microscopic Description (Cancer only)
Other Information (Limit 700 characters)
Type of Concern
Diagnosis (50 character max)
Age at Onset
Treatment (50 character max)
Path Report: Microscopic Description (Cancer only)
Other Information (Limit 700 characters)
Type of Concern
Diagnosis (50 character max)
Age at Onset
Treatment (50 character max)
Path Report: Microscopic Description (Cancer only)
Other Information (Limit 700 characters)
Agency Information
Name
Agency
Phone Number
Extension
QuickQuote Reference
Send Confirmation/Summary Email?
Other Carriers (Max 3)
Carrier #1 Email
Carrier #2 Email
Carrier #3 Email
By checking this box I accept the QuickQuote terms and conditions:
Legal & General America will do its best to issue a policy that matches the tentative offer you’ll receive in response to this request. The QuickQuote will be non-binding and based solely on the information you have provided above. A final decision will be made after receipt, review and assessment of a formal application, age and amount requirements, any interim Attending Physician Statement(s), and any required facultative reinsurance review. Our formal review and risk assessment will include review of Medical Information Bureau and Motor Vehicle Record reports, identity verification, no finding suggestive of a hereditary cancer syndrome, and financial documentation necessary to justify in force and applied for coverage. The QuickQuote will be valid for 60 days from the date of the response and a copy of the QuickQuote must accompany the formal application.
© 2024 Legal & General America. All Rights Reserved. Legal & General America life insurance and retirement products are underwritten and issued by Banner Life Insurance Company, Urbana, MD and William Penn Life Insurance Company of New York, Valley Stream, NY. Banner is licensed to do business in 49 states and the District of Columbia. William Penn does business exclusively in New York; Banner does not solicit business there. The Legal & General America companies are part of the worldwide Legal & General Group.
© 2024 Legal & General America. All Rights Reserved. Legal & General America life insurance and retirement products are underwritten and issued by Banner Life Insurance Company, Urbana, MD and William Penn Life Insurance Company of New York, Valley Stream, NY. Banner is licensed to do business in 49 states and the District of Columbia. William Penn does business exclusively in New York; Banner does not solicit business there. The Legal & General America companies are part of the worldwide Legal & General Group.