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    Questionnaires

    5a.  Alcohol Usage

    5b.  Cancer

    5c.  Diabetes

    5d.  Driving

    5e.  Drug Usage

    5f.   Heart Disorder

    5g.  Stroke

    5h.  Tobacco Usage

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    Heritage Life Insurance Company

    227 West Monroe Street, Suite 3775

    Chicago, IL 60606

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