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Life Insurance Quote



Gender *

Male
Female
 







Preferred Contact Method *

Phone
Email
 
Are you currently a member of UICCU? *

Yes
No
 
Marital Status *

Not Married
Married
 

Desired Type of Life Insurance *

Term
Permanent
 




Tobacco Use?

Cigarettes

Yes
No
 
Smokeless Tobacco

Yes
No
 

Please Read and Signify That You Understand This Important Disclosure
The information contained herein is provided for general informational purposes and is not intended to be a contract, nor is the information a complete description of all terms, conditions, and exclusions applicable to the products and services described. This does not constitute an offer of coverage or the purchase of insurance. No coverage may be added, changed, or bound as a result of submitting this request for information or quotation of insurance. All coverage must be confirmed by UICCU Insurance in writing subject to an acceptable signed application meeting the underwriting guidelines of the Insurance Company.
To better serve you and to be able to offer you an accurate quote, UICCU Insurance will need to collect information from consumer reporting agencies, such as driving record, claims, and credit history reports, and may need to share certain information with qualified third party associates. UICCU Insurance will not sell customer information or allow those who are doing business on your behalf to use our customer information for their own marketing purposes. Future reports may be used to update or renew your insurance.