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State
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Amer. Samoa
Birthdate
January
February
March
April
May
June
July
August
September
October
November
December
1
2
3
4
5
6
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8
9
10
11
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22
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31
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1964
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1981
1982
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1984
1985
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1990
1991
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1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
Gender
Male
Female
Smoker / Tobacco
No
Yes
Health Class
Preferred Plus
Preferred
Regular Plus
Regular
Type of Insurance
1 Year Level Term
5 Year Level Term
10 Year Level Term
15 Year Level Term
20 Year Level Term
25 Year Level Term
30 Year Level Term
35 Year Level Term
To Age 65 Level
To Age 70 Level
To Age 75 Level
To Age 80 Level
To Age 85 Level
To Age 90 Level
To Age 95 Level
To Age 100 Level
To Age 105 Level
To Age 110 Level
Other Term
10, 20, 30 Year Term
All Level Term Products
15 Year Return of Premium
20 Year Return of Premium
25 Year Return of Premium
30 Year Return of Premium
15, 20, 30 Year with ROP
All Return of Premium Products
To Age 121 Level (No Lapse U/L)
To Age 121 Level - Pay to 100
To Age 121 Level - Pay to 65
To Age 121 Level - 20 Pay
To Age 121 Level - 10 Pay
To Age 121 Level - Single Pay
All To Age 121 Level Products
Amount of Insurance
$10,000
$25,000
$50,000
$75,000
$100,000
$125,000
$150,000
$175,000
$200,000
$225,000
$250,000
$300,000
$350,000
$400,000
$450,000
$500,000
$550,000
$600,000
$650,000
$700,000
$750,000
$800,000
$900,000
$1,000,000
$1,100,000
$1,250,000
$1,500,000
$1,750,000
$2,000,000
$2,500,000
$3,000,000
$4,000,000
$5,000,000
$6,000,000
$7,000,000
$8,000,000
$9,000,000
$10,000,000
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