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 justincaseinsurance.com

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1-888-977-7778 Monday-Friday 9-9, Saturdays 11-5, EST. Our International Number is: 1-514-630-6116

Toll-Free Fax:
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Courrier Address:
147 Place Terry Fox
Kirkland, Quebec
CANADA H9H 4Z5

Regional Offices:
410-2001
McGill College Avenue
Montreal, Quebec
CANADA H3A1G1


200-1122 4 Street SW
Calgary, Alberta
CANADA T2R1M1

 
Guaranteed Issue Life Insurance to Protect Your Family
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For professional advice and help by a licensed Life Insurance Agent on duty now to help you choose and apply for the lowest cost and best value buy for your Life Insurance coverage based on your personal situation, complete the following Request To Quote For Life Insurance.

Your Personal Data

 
Your Name:
Street Address:
City:
Province:
Postal Code:
E-Mail (REQUIRED):
E-Mail again for accuracy:
Phone:
Fax (optional):
 
Marital Status:
Single Married
Homeowner?
Yes No
 
Currently Insured?
(If yes, list carrier, and # of years
continuous. If none, type N/C)
 
Unusual Activities?
(If you engage in unusual activities such as scuba diving, airplane flying, rock climbing, etc., list them here.)
 


 

 
Underwriting Information:
 
Name of Insured:

Sex (M/F): Smoker or
Non-Smoker?:
Height: Weight:
 
Amount of Coverage Desired? $


Type of Coverage
(See Definitions Below)
Term Life Whole Life
Universal Life

Term Life Insurance is low cost insurance that guarantees a death benefit for a limited time or period, for instance, up to age 85. It is guaranteed renewable at various intervals such as every 10 or 20 years, without proof of insurability at renewals and is guaranteed convertible to Permanent or Universal Life in many cases prior to age 70 of the Life Insured(s).

Whole Life (or Permanent Life) is intended to guarantee a death benefit for as long as the Life Insured lives. It provides a savings component that is accessible to the insured through a Policy Loan or the cancellation of the Policy. With the plan design, it is possible to pay all premiums due in 20 years with a death benefit guaranteed for life and guaranteed cash values to borrow on. Whole Life Insurance Policies requires little ongoing management once in force.

Universal Life guarantees a death benefit and makes it possible to tax shelter deposits and investment gains from a managed choice of investment funds that meet your investment profile. The regular review and management of your investments within your Universal Life is highly recommended. Ideal Insurance Product for Canadian Residents that seek a death benefit guarantee and cannot make more allowable contributions to their RRSP, Spousal RRSP.



 
If Term, list years of Level
Premium. (1yr., 5yr., 10yr., 20yr.):
 
List Any Health Problems:
 
List Any Medication You Take:
 
Reason for Buying Life Insurance:
 
Send my quotation via: E-Mail Fax
Regular Mail
Call Me by Phone
 


 

 
 
Thank you for filling out this form COMPLETELY!
 

We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

Yes, I Agree. Please Send Me a
Life Insurance Quote NOW!
 

 

Save Time & Money.
Free, Fast & Easy To Apply.

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Quote in 60 Seconds!
Instant Life Quote - STEP 1 of 2
Your Contact Information:
Your Name:
Your Phone #
(xxx-xxx-xxxx):
Email Address:
Please select your Province of Residence, (or select "Other" if not listed):
Click button below for final screen, and final seven
simple underwriting questions

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This page was last updated on : April 19, 2008
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