Contact us 

1-877-443-0101

 

 

      Your Critical Illness Insurance Quote - Simplified Issue

No medical tests and examination

 

* represents mandatory fields

Applicant  
   
Name *
Gender * Male      Female
Date of Birth *   dd-mmm-yyyy (example: 10Mar1985)
Smoker? *

Yes    No

E-mail *
City*
Province        
Phone Number
   
 Coverage Options
   
Coverage Amount    $             (min $5,000 max $100,000)
Return of Premium on Surrender/Expiry  
Premium Frequency    
   
   

 

 

        Additional Information, Notes and Questions

 

Please contact me to follow up with my quotes:   by phone        by e-mail  

 
 

Please confirm your E-mail   

 

 

Your quotes will be emailed you within one business day.

 

If you have any questions or need help to fill in the form call

at 416-493-0101 (toll free 1-877-443-0101)

 

 

Revised: March 20, 2017