Question 1 : Do you possess an active U.S. Bank Account (Checking/Savings) with funds over the last 6 months? *

Yes

No

Question 2 : Do you intend to be physically present in California for a minimum of 3 consecutive weeks in the next 60 days (for policy signing and medical exam)? *

Yes

No

Question 3 : Do you possess a valid U.S. Taxpayer ID (SSN or ITIN) for administrative and tax purposes? *

Yes

No

Question 4 : Do you or your immediate family own U.S. assets (Real Estate, Business, or Investments) with a value over $100,000? *

Yes

No

Question 5 : What is the minimum amount of death benefit (capacity) you need to protect your family's future income (e.g., $500,000, $1 Million+)? *

Yes

No