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Get Liberty Life Assurance Company Of Boston Evidence Of Insurability Form For Life Insurance

E ALSO Life Rev. (12/05) IMPORTANT: You must answer YES or NO to each of the following questions. Do not leave boxes blank as failure to complete all boxes with either YES or NO response will cause application to be returned. Are any of the applicants now under treatment for, or have had or been told they had, any of the following diseases or symptoms: (If YES, provide the name to whom it applies, with full details and dates.) 1. BACK OR SPINAL DISORDER NO YES 2. INTESTINAL DISOR.

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