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Your Critical Illness Insurance Quote - Simplified Issue

No medical tests and examination


* represents mandatory fields

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

Yes    No

E-mail *
Phone Number   (if you want an insurance broker call you)
 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 04, 2021