Mortgage Protection Application - Your Own Bank

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Get protection for your family

Gender

Male Female

Date of birth

Next, household & general information

Do you have a spouse or partner?

Yes No

Smoker?

Yes No

Height

Weight

Spouse/Other Name

Date of Birth

Age

Height

Weight

Smoker?

Yes No

Medical Concerns

Do you have any medical concerns?

Yes No

Partner medical concerns?

Yes No

High Blood Pressure

Yes No

Heart Attack

Yes No

Stroke

Yes No

Cancer

Yes No

Diabetes

Yes No

High Cholesterol

Yes No

DUI/Substance Abuse

Yes No

Any Surgeries

Yes No

Any Diseases

Yes No

Accidents

Yes No

Notes

High Blood Pressure

Yes No

Heart Attack

Yes No

Stroke

Yes No

Cancer

Yes No

Diabetes

Yes No

High Cholesterol

Yes No

DUI/Substance Abuse

Yes No

Any Surgeries

Yes No

Any Diseases

Yes No

Accidents

Yes No

Please enter a valid email address

Medications

Are you taking medications?

Yes No

Is the partner taking medications?

Yes No

Applicant Meds List

Partner Meds List

Mortgage Information

Loan Amount

Lender

Mortgage Term

Monthly Payment

Miscellaneous

Occupation

Occupation (partner)

Availability

Availability (partner)

Beneficiary Full Name & Relationship

Do you have children?

Yes No

Children Age

Children Age

Children Age

Contact information

Phone Number

Email

Your personal information is kept secure.

Terms of Service

Your Own Benefits™ Risk Protection Analysis Make the Repair of Your Life! Protection Guidance Priority Support Crypto & AirDrops Policy Review & Updates Tax Advantages Portability Wealth Transfer Peace of Mind Business Continuity

Your Own Benefits™ Risk Protection Analysis Make the Repair of Your Life! Protection Guidance Priority Support Crypto & AirDrops Policy Review & Updates Tax Advantages Portability Wealth Transfer Peace of Mind Business Continuity

Most common mortgage terms are 15, 20 and 30 years.

If you don't see the meds you are taking in the suggestive results, manually type it in:

Write all medical concerns not mentionsed above

This is the current loan amount

If you don't see the meds you are taking in the suggestive results, manually type it in:

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