GNI P2 Intl Term Life Here is what we need to know. To give you the most accurate quote on long-term international term-life (or AD&D) insurance, our carriers require the following information. Neither they, nor we, will bug you except to give you the quote you are looking for – If you've ever gotten an insurance quote before, you know that's nice! Also, term-life policies are individual policies. Husband and wife must complete separate quote requests (Skype us at 'goodneighborinsurance' if you have questions!) Can you tell us a little more?First Name Last Name Email* If currently living in the USA: Your ZIP code Country of Residence For what City & Country will policy be in effect:* What other Cities/Countries will you be visiting/living in? Date of departure? Month Day Year Return date? Month Day Year Desired length of coverage: When would you like this policy to become effective: Month Day Year Annual Income: (Required)* Amount of insurance (in U.S. dollars): You may check up to 3 for quotes. $100,000 $150,000 $200,000 $250,000 $300,000 $350,000 $400,000 $500,000 $600,000 $700,000 $800,000 $900,000 $1,000,000 Other (indicate below) Maximum allowed 10 times your annual income.Other amount of coverage requested: A bit more about you:Gender Male Female Your Age Date of Birth Month Day Year Height? (Indicate inches/cm) Weight (Indicate lbs./kg.) Are you a U.S. Citizen?* Yes No If no, your citizenship: What kind of work do you do: Organization/Company: About your health:Have you been turned down for life insurance? Yes No When/Why were you declined: Under a doctor's present care for a medical condition? Yes No For what? Medication(s)? Have you had any of the following medical conditions? Yes No Condition(s) Cancer Heart Disease/Attack High Blood Pressure Stroke High Cholesterol Diabetes HIV / AIDS Mental Illness If yes, please tell us who it is and describe Additional medical conditionsDo you use tobacco products? If "Yes", below please describe usage: Yes No Quantity? How often? Any further requests/comments?Lastly, how did you hear about us? We're open 8:00-17:00 MST Monday-Friday. On work days we provide quotes within 24 hours, and usually much sooner than that. If your request is submitted over the weekend, we will get a quote to you before the end of the work day on Monday.EmailThis field is for validation purposes and should be left unchanged.
