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Roductive organs, or sexually transmitted disease? ....... Yes No f. connective tissue disease, systemic lupus (SLE), arthritis, or any disorder of the back, joints, muscles, or nervous system? .. Yes No g. any disease or disorder of brain, eyes, throat, skin, thyroid or lymph nodes? ......................................................................... Yes No 3. Within the past 5 years has any Proposed Insured: a. been convicted of any misdemeanor or felony charge (including DUI or DWI), had.

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