Halo
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Ellegibility Form
To help us determine your eligibility for insurance coverage, please complete the our with accurate and up-to-date information. Tap on the next button when you are ready!
What brings you here? Select all that apply.
Create a safety net for my loved ones
Protect others from inheriting my debts
Protect my income until retirement
Accumulate money with my policy
Cover funeral expenses (e.g. funeral, medical)
I’m not sure
Who depends on you financially?
Spouse or Partner
Children
Parent
Other
When would you like to be covered by life insurance?
I'm ready today
Within a week
In a few months
I'm not sure
Provide your sex at birth
Male
Female
How is your health?
Average
Great
Excellent
Do you currently use nicotine products?
No
Yes
How many children do you have under 18?
0
1
2
3
4+
Do you have an Estate Plan or Will in place?
No
Yes
I am not sure
About how much remaining debt/mortgage do you have?
Do you have an idea of how much coverage you'd like?
I am not sure
Yes
How much coverage are you looking for?
What country were you born in?
What state were you born in?
Are you a citizen or permanent resident of the USA?
U.S Citizen
Permanent Resident (Green Card)
None of the above
What is your Zipcode?
What’s your birthdate?
First name
Last name
Email
Congratulations!
You have completed our form, now just tap on the submit button to get the process started.
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