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Shannon Kennedy / TVVlachos Insurance GroupRR 4 Box 180A Montrose, PA 18801 800-279-2290 x209 -- (fax) term@sasid.com
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| Benefits will be adjusted for misstatements of age
or sex. Answering the questions on this form will not result in a determination
of your eligibility for life insurance coverage. Company and product
availability varies by state. |
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| Some products not available in certain states. |
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