Your Application

• Before we start your application, we first need to get you a quote. Your insurance application will be based on the quoted coverage, and it's important that we complete this step first.

  
  

  To obtain a quote, tell us a bit about yourself and enter the amount of coverage you want. A quote for the monthly premium and suggested product will follow.

• Date of Birth
• • MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember
  • Day12345678910111213141516171819202122232425262728293031
  • Year202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900
  Date of Birth MonthDate of Birth DayDate of Birth Year
• Gender
  Gender

  GenderMale Gender Male

  GenderFemale Gender Female
• What is the definition of a non- smoker? Means an individual who has not used any form of tobacco, nicotine, or marijuana, including the use of cigarettes, e-cigarettes, cigars, cigarillos, chewing tobacco, nicotine gum or patches or marijuana product, during the twelve (12) month period before the Application dateSmoker Status
  Smoker Status

  Smoker StatusYes Smoker Status Smoker

  Smoker StatusNo Smoker Status Non Smoker
• Where do you currently live?
  <choose>AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland and LabradorNova ScotiaNorthwest TerritoriesNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon
  Where do you currently live?

Don't know how much coverage you need? Try our coverage calculator