| 1)
|
Is the proposed insured currently: Bedridden at home or confined in a hospital, nursing home, or long term care facility? |
|
|
|
| 2)
|
Has a member of the medical profession ever diagnosed or treated the Proposed Insured for Acquired Immune Deficiency Syndrom (AIDS) or AIDS Related Complex(ARC)? |
|
|
|
| 3)
|
Within the past year has the Proposed Insured: |
|
|
|
| |
(a) had a stroke, angina, heart attack or failure, cardiac or circulatory surgery, or Diabetes (requiring shots)? |
|
|
|
| |
(b) had or been treated for internal cancer or melanoma, leukemia, kidney failure, Alzheimer's disease, alcoholism, drug dependence, or liver cirrhosis? |
|
|
|
| |
(c) used oxygen equipment to assist in breathing or had any amputation caused by disease? (nc life.com) |
