Hero Life
Welcome to Hero Life Insurance!
Request Form – Test Page
Step
1
of
7
14%
What type of coverage do you want?
1
‐‐‐ Select one ‐‐‐
No Medical Guaranteed Life Insurance
Term Insurance
Accidental Death & Dismemberment
Critical Illness Insurance
Name
First
Last
2
Mobile Phone
3
Email
4
Do you smoke?
Yes
No
5
Are you man or woman?
Man
Women
6
How committed are you to insuring and protecting your family?
7
1
2
3
4
5
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10