Contact Infomation:
  Name: David Roberts
  Address: 2440 Spalding Drive
  City: Dunwoody
  State: GA
  Zip: 30338
  Primary Phone: (404) 847-1900 Day,Evening
  Alternate Phone: (770) 399-6742 Day,Evening
  Email: roberts1962@gmail.com

Insured Information:
             Sex      dob       Height  Weight
          ------- ---------- --------- ---------
  Primary: Male   05/28/1962    6'1"    175
  Spouse:  Female 07/22/1970    5'0"    115
  Child 1: Male   06/30/1996
  Child 2: Female 09/05/1998
  Child 3:
  Child 4:

Insureds that currently use tobacco: None
  Currently Insured: Yes
  If insured, carrier name: Mega Life and Health
  Self Employed: Yes
  Occupation: Consultant

Policy Information:
  Full Time Student: No
  Duration of Coverage needed: Greater than 6 months
  Diabetes: No
  Date Coverage needed: 1/1/2009

Health Conditions, Medications, and Other Information:

  Is anyone to be covered currently pregnant? No

Other Health Conditions and Information:

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