Birth Date JanFebMarAprMayJunJulAugSepOctNovDec 12345678910111213141516171819202122232425262728293031 Gender Male Female Ever used tobacco or related substances? Yes No   CigaretteNeverlast 12 monthsMore than 1 yrMore than 2 yrsMore than 3 yrsMore than 4 yrsMore than 5 yrsMore than 6 yrsMore than 10 yrsMore than 15 yrsMore than 25 yrs CigarNeverlast 12 monthsMore than 1 yrMore than 2 yrsMore than 3 yrsMore than 4 yrsMore than 5 yrsMore than 6 yrsMore than 10 yrsMore than 15 yrsMore than 25 yrs PipeNeverlast 12 monthsMore than 1 yrMore than 2 yrsMore than 3 yrsMore than 4 yrsMore than 5 yrsMore than 6 yrsMore than 10 yrsMore than 15 yrsMore than 25 yrs SnuffNeverlast 12 monthsMore than 1 yrMore than 2 yrsMore than 3 yrsMore than 4 yrsMore than 5 yrsMore than 6 yrsMore than 10 yrsMore than 15 yrsMore than 25 yrs CigarelloNeverlast 12 monthsMore than 1 yrMore than 2 yrsMore than 3 yrsMore than 4 yrsMore than 5 yrsMore than 6 yrsMore than 10 yrsMore than 15 yrsMore than 25 yrs ChewNeverlast 12 monthsMore than 1 yrMore than 2 yrsMore than 3 yrsMore than 4 yrsMore than 5 yrsMore than 6 yrsMore than 10 yrsMore than 15 yrsMore than 25 yrs MarijuanaNeverlast 12 monthsMore than 1 yrMore than 2 yrsMore than 3 yrsMore than 4 yrsMore than 5 yrsMore than 6 yrsMore than 10 yrsMore than 15 yrsMore than 25 yrs PrescribedNeverlast 12 monthsMore than 1 yrMore than 2 yrsMore than 3 yrsMore than 4 yrsMore than 5 yrsMore than 6 yrsMore than 10 yrsMore than 15 yrsMore than 25 yrs Province Face Amount Face Amount$ 25,000$ 30,000$ 35,000$ 40,000$ 45,000$ 50,000$ 55,000$ 60,000$ 65,000$ 70,000$ 75,000$ 80,000$ 85,000$ 90,000$ 95,000$ 100,000$ 125,000$ 150,000$ 175,000$ 200,000$ 225,000$ 250,000$ 275,000$ 300,000$ 325,000$ 350,000$ 375,000$ 400,000$ 425,000$ 450,000$ 475,000$ 500,000$ 550,000$ 600,000$ 650,000$ 700,000$ 750,000$ 800,000$ 850,000$ 900,000$ 950,000$1,000,000$1,250,000$1,500,000$1,750,000$2,000,000$2,250,000$2,500,000$2,750,000$3,000,000$3,500,000$4,000,000$4,500,000$5,000,000$6,000,000$7,000,000$8,000,000$9,000,000$10,000,000$11,000,000$12,000,000$13,000,000$14,000,000$15,000,000$16,000,000$17,000,000$18,000,000$19,000,000$20,000,000$21,000,000$22,000,000$23,000,000$24,000,000$25,000,000$26,000,000$27,000,000$28,000,000$29,000,000$30,000,000 Premium modeAnnualSemi-AnnualQuarterlyMonthly Product Type Health Risk Super PreferredPreferredSelect RegularRegular Physique   Please Note: Comparisons and quotes are intended for guidance and educational purposes only. The consumer is urged to seek the advice of independent life insurance advisors. E.&.O.E. WinQuote™ is a trademark of CompuOffice Software Inc.