* - Optional Fields

Information obtained from this form will be kept confidential and will only be used to help established a quote.

Name:

E-mail:

Phone #:

Address:

*

City:

Province:

Date of Birth: (DD/MM/YY)

/ / 19

Gender:

Male Female

Smoker:

Yes No

Amount of Coverage

What is your contact preference?

Phone E-mail


   

Lowest Ten Year Term Life Insurance.

Up to $1,000,000 Coverage

FEMALE

NON-SMOKERS

RATES*

MALE

NON-SMOKERS

RATES*

Age

$250,000

$500,000

$1,000,000

$250,000

$500,000

$1,000,000

30

$12

$20

$30

$15

$26

$47

40

$17

$28

$47

$20

$34

$60

45

$21

$37

$67

$26

$47

$87

50

$27

$48

$88

$39

$71

$134

60

$58

$108

$210

$79

$151

$295

You may wish to convert this term life policy to that of tax-advantaged Universal Life insurance. To find out if you qualify, fill out the form above. * Monthly rates. E&O E

*Rates subject to change, monthly rates shown.