What type of coverage do you require? Select from the choices below.

• Renewable coverage lasting from two weeks up to a maximum of 24 months.
  * Although the maximum length of coverage on the initial application is 12 months, it can automatically re-new for a total coverage period of up to 24 months.
• This is a permanent policy and has no predetermined length of coverage.
  * The initial policy period will show 12 months. You will have the opportunity to change the mode and method of payment. This policy will remain in-force as long as you continue to make your premium payments.