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13. Has the Proposed Insured ever filed for bankruptcy? (If "Yes," list chapter filed and date(s) YES discharged) 14 Height ft ICC17 Form CLI-1001-IIPRC (1/17) in Weight NO lbs Page 1 of 3 PERSONAL HISTORY In Continuation of Application for Individual Life Insurance Reinstatement GIVE FULL DETAILS (IN #22) TO ANY QUESTIONS ANSWERED "YES" 15. Has the Proposed Insured ever been diagnosed, treated, tested pos.

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