1

Enter Names

(*Optional)

Client’s Name:

Advisor’s Name:

2

Client’s Date of Birth

(*Required)

3

Client’s Sex at Birth

(*Required)

FemaleMale

4

Client’s Smoking Status

(*Required)

Non-smokerSmoker

5

Select a Province

6

Choose an Amount of Coverage

(*Required)

Face Amount:

Current existing Critical Illness or Final Expense coverage with Specialty Life
(New blended rates)

7

Select a Product

(*Required)

8

Choose a Risk Class

(*Required)

9

Select a Term

(*Required)

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Your Summary

Monthly Rate

$00.00

Yearly Rate

$000.00

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