DI Quote Request August 2, 2022 DIProtection DI QR Advisor Name Client Name Date of Birth Or Age Gender Male Female Nicotine Yes No StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificOccupation /Duties/Specialty Income Benefit Amount Elimination Period 30 Days 60 Days 90 Days 180 Days 365 Days Benefit Period 2 Years 5 Years 10 Years To age 65 To age 67 To age 70 Own Occ Own Occ Own Occ and not working Best Available Other, see notes below Contract Non-Can Guaranteed Renewable (if available) Both Non-Can and GR (if available) Riders Residual FIO 3% COLA 6% COLA CAT MN Discount FIO Amount CAT Amount Other Coverage Notes:
