Quote To receive a free quote, please complete the questions below. Life Insurance Approval Process Bay Plan Quote Form Do you currently use tobacco or nicotine in any form (e.g., cigarettes, cigars, chewing tobacco, vaping, nicotine gum, patches)? Select Yes or No YesNo If yes, please specify type, quantity, and frequency: If you previously used tobacco or nicotine, when did you quit? Have you ever been diagnosed with any of the following: cancer, diabetes, or heart-related conditions? Select Yes or No YesNo If yes, please provide details (including dates and current status): Have you been hospitalized as an inpatient within the past two (2) years?: Select Yes or No YesNo If yes, please provide details (reason and dates): Please Complete All Fields Below: 12 + 14 = Send
