Find Out if You Qualify to Sell Your Policy
Please complete the form below to take the next step toward selling your policy.
Name
*
First Name
Last Name
Phone Number
*
Please enter a valid phone number.
Email
*
example@example.com
Policy Death Benefit
*
Insured's Date of Birth
*
-
Month
-
Day
Year
Insured's Health Status
*
Please Select
Excellent
Good
Fair
Poor
Terminal
Insured's Gender
*
Please Select
Male
Female
Are you the insured?
*
Yes, I am the insured
No, I am not the insured
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Policy Information
We need to evaluate your policy information. Please provide accurate answers or respond "I don't know" if you are unsure.
What is the policy type?
*
Please Select
Term Life
Universal Life
Whole Life
Other
Not sure
How long has the policyowner owned the policy?
*
Please Select
Less than 2 years
2-3 years
4-5 years
6-10 years
11-15 years
16-20 years
21-25 years
More than 25 years
Not sure
Did you receive the policy from a current or former employer?
Yes
No
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Insured's Health History
Providing an accurate health history is important in determining eligibility.
Has the insured ever been diagnosed with any of the following? Select all that apply.
ALS (Lou Gehrig's Disease)
Alzheimer's Disease or Dementia
Cancer
Chronic Lung or Respiratory Disease (other than Asthma)
Heart Disease (Including Pulse or Rhythm Issues)
Insulin Dependent Diabetes
Kidney or Renal Disease
Liver Disease
Multiple Sclerosis (MS)
Parkinson's Disease
Stroke / Cerebrovascular Disease
Not Applicable
Does the insured use any assistive devices or ongoing medical support such as homecare hospice or continuous therapy?
Yes
No
Please provide any additional health information for the insured that you would like us to consider.
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Additional People Insured On The Policy
Some policies insure multiple people, often a spouse or significant other. If the policy insures more than one person, please provide their information.
Is there another insured person on the policy who is still living?
*
Yes
No
Second insured's Name
*
First Name
Last Name
Second Insured's Health Status
*
Please Select
Excellent
Good
Fair
Poor
Terminal
Second insured's Date of Birth
*
-
Month
-
Day
Year
Date
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Additional Policies
Some people maintain more than one life insurance policy. Evaluating all of your policies at once may improve the insured's ability to qualify.
Do you have any additional life insurance policies?
*
Yes
No
What is the total death benefit of the additional policy or policies?
*
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How did you hear about Golden Life Settlements?
Please Select
Facebook
Instagram
Google
Family or Friend
Other
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