AAI Omaha
All American Insurance of Omaha
(402) 932-1500
10410 S 144th St | Suite #2A | Omaha, NE 68138
Fax: (402) 932-1501
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Life Insurance
Life Insurance
Take care of your loved ones under circumstances you can’t control!
If you are human, leave this field blank.
CLIENT INFORMATION
Primary Info
Name
DOB
Age
Height
Weight
Sex
Male
Female
Tobacco
Yes
No
General Health
Spouse Info
Spouse Name
Spouse DOB
Spouse Age
Spouse Height
Spouse Weight
Spouse Sex
Male
Female
Spouse Tobacco
Yes
No
Spouse General Health
PRODUCT: LIFE INSURANCE
Permanent
Term
10
20
30
Amount of Coverage
Waiver of Premium
Spouse
Children
Accidental Death
Return of Premium
PRODUCT: LONG TERM CARE
Daily Benefit
Monthly Benefit
Benefit Period
Elimination Period
Optional
Return of Premium
Spouse
Spousal Shared Care
Spouse Waiver of Premium
Spouse Survivorship
Inflation Period
Preferred Premium Range
PRODUCT: DISABILITY INCOME
Type
Short Term
Long Term
Accident Only
Occupation
Income
Monthly Benefit
Benefit Period
Elimination Period
Optional
Social Insurance Supplement
Return of Premium
Cost of Living Adjustment
Future Increase Option
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