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Your total estimated monthly premium before applicable taxes:
 
BUNDLED PLAN:

Coverage type:  

Monthly premium:  

Term life insurance:   (member only)

Long-term disability insurance:   (member only)

Accidental death insurance:   ( )

Extended healthcare insurance: Option 1 ( )

YOUR INFORMATION:

Your province:  

Your gender:  

Your age:  

Do you smoke?  

Do you have a spouse?  

Do you have dependent child(ren)?  

YOUR SPOUSE:

Spouse's gender:  

Spouse's age:  

Does your spouse smoke?  

TERM LIFE INSURANCE:

Your coverage:  

Monthly premium:  

Spouse's coverage:  

Spouse's monthly premium:  

Would you like to cover your child(ren)?:  

Child(ren)'s monthly premium:  

ACCIDENTAL DEATH AND DISMEMBERMENT INSURANCE:

Coverage type:  

Monthly premium:  

Coverage:  

EXTENDED HEALTHCARE INSURANCE:

Coverage type:  

Monthly premium:  

Plan:  

CRITICAL ILLNESS INSURANCE:

Your coverage:  

Your monthly premium:  

Spouse's coverage:  

Spouse's monthly premium:  

Dependent child(ren) coverage:  

Spouse's monthly premium:  

LONG-TERM DISABILITY INSURANCE:

Your annual earned income:  

Coverage amount:  

Elimination period:   days

Base monthly premium:  

Would you like “Cost of Living Adjustment” rider?:  

“Cost of Living Adjustment” monthly premium:  

OFFICE OVERHEAD EXPENSE INSURANCE:

Elimination period:   days

Monthly premium:  

Coverage:  

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