What is your primary motivation for seeking insurance today?

(Check all that apply)

Secure my mortgage

Secure my family's well-being

Replace my current insurance

Cover end-of-life expenses

Buy whole or universal life insurance

Looking into disability insurance

Looking into critical illness insurance

Buy Insurance for my child

Looking into long term care insurance

Buy home, auto or health insurance

I'm just browsing

Insurance Needs

Select an Option - Insurance Amount Requested For Child*

$10,000
$15,000
$20,000
$25,000
$30,000
$35,000
$40,000
$45,000
$50,000
No elements found. Consider changing the search query.
List is empty.

Your Child's Details

Who would you like to get coverage for?

Child's Age*

30 days to 1 year
1 Year
2 Year
3 Year
4 Year
5 Year
6 Year
7 Year
8 Year
9 Year
10 Year
11 Year
12 Year
13 Year
14 Year
15 Year
No elements found. Consider changing the search query.
List is empty.

What’s your gender?

Male

Female

Date of Birth

Date of birth *

Your Child's Information

Weight

Were any of the children born prematurely or with abnormalities at birth diagnosed by a medical professional?

Yes

No

Are you the mother, father or the legal guardian of the child to be insured ?

Yes

No

Does the child to be insured reside with you at least 4 days per month, every month of the year ?

Yes

No

Was the child to be insured born in Canada ?

Yes

No

Has the child to be insured ever been declined, deferred or postponed, for life or critical illness insurance, or offered coverage with an exclusion ?

Yes

No

Declaration of Insurability

Have two (2) or more family members of the child to be insured (mother, father, brother or sister) been diagnosed before the age of sixty (60) with any of the following disorders: Heart disease, cerebral vascular accident or stroke, aneurysm, diabetes or cancer ?

Yes

No

Has any biological family member of the child to be insured (mother, father, brother or sister) ever had or been diagnosed with any of the following disorders: Huntington's disease, polycystic kidney disease, Parkinson's disease, cystic fibrosis, Alzheimer's disease, familial polyposis of the colon, multiple sclerosis, Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig's disease) or any other hereditary disorders ?

Yes

No

Has the child to be insured ever had any symptoms of or ever been treated for any of the following disorders: malformations or other disorders of the heart, malformations or disorders of the arteries, circulatory disorders, heart murmur, diabetes, endocrine disorders, elevated cholesterol or high blood pressure ?

Yes

No

Has the child to be insured ever had any symptoms of or ever been treated for any of the following disorders: cancer, tumors, disorder of the lymph nodes or other glands, leukemia, anemia, inflammatory disorders or disease, Human Immunodeficiency Virus (HIV) or any other immunological disorders ?

Has the child to be insured...

Yes

No

Has the child to be insured ever had any symptoms of or ever been treated for any of the following disorders: hearing loss, partial or total blindness, pervasive developmental disorders, autism, mental or psychological disorders, intestinal, renal, rheumatoid or neurological disorder, respiratory disorders excluding asthma that is well controlled ?

Yes

No

Is the child to be insured developmentally delayed physically, mentally or socially, or been diagnosed with a hereditary, familial or congenital disorder or deformity, had an amputation or physical limitation ?

Yes

No

Is the child to be insured under medical evaluation or receiving treatment of any type for any disorder other than a benign condition such as a cold or flu ?

Yes

No

Has the child to be insured ever taken prescription medication that was not prescribed to him or her, used marijuana or other drugs ?

Yes

No

Within the past 2 years, has the child to be insured been hospitalized for observation, care, diagnosis or treatment ?

Yes

No

Has the child to be insured been advised to have any testing, consultation, evaluation, surgery or other investigation that has not been completed ?

Yes

No

Your Details

NEXT