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How do you describe yourself?
Do you Smoke?
Within the past 12 months, have you used by any means a substance or product containing tobacco or nicotine (excluding cigars), or have you smoked (including electronic vaporizer or “vaping”) marijuana more than six times per week? If Yes, smoker rates are applicable.

Tobacco use:
How long have you been smoking?
Tell us when you were born
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Life insurance is a tricky thing and can impact your near and distant future.

See your options, analyse them and make an informed policy choice that will sustain you a lifetime and beyond.

Choose the option that fits your needs

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LET US CALCULATE YOUR COVERAGE
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Choose the option that fits your needs

REGULAR UNDERWRITING
Is an evaluation of health, occupation, hobbies, lifestyle, characteristics, and financial status that may affect coverage plan and premiums.
Standard underwriting process that requires thorough examination of medical information.
REGULAR UNDERWRITING
SIMPLIFIED UNDERWRITING
Means fewer questions, no medical exam and you may be immediately qualified in 60 minutes or less.
A streamlined underwriting process that requires less medical information and documentation.
SIMPLIFIED UNDERWRITING
No medical exam Fewer questions
REGULAR UNDERWRITING
SIMPLIFIED UNDERWRITING
No medical exam Fewer questions

Showing the Best Policies for Your Needs

Coverage Amount  $500,000
$500,000
Policy Length  10 years
10 years
Regular Underwriting - This type of insurance is typically for applicants with good to excellent health.
The rates below require Full Underwriting. For Simplified Underwriting, switch to Simplified.
Simplified Underwriting - A life insurance policy you may be instantly approved for with minimal health questions.
This type of insurance is typically meant for people with pre-existing conditions who need to obtain life insurance immediately and/or do not wish to submit medical exam requirements.
Simplified
A life insurance policy you may be instantly approved for with minimal health questions. This type of insurance is typically meant for people with pre-existing conditions who need to obtain life insurance immediately and/or do not wish to submit medical exam requirements.
Regular
This type of insurance is typically for applicants with good to excellent health. The rates below require Full Underwriting. For Simplified Underwriting, switch to Simplified.
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Eligibility Assessment Part 1

1. Does your weight exceed the weight corresponding to your height in the following table:
Height Weight
ft/in. cm lbs kg
4'10" 147 192 87
4'11" 150 198 90
5'0" 152 205 93
5'1" 155 212 96
5'2" 157 219 99
5'3" 160 226 103
5'4" 163 233 106
5'5" 165 240 109
5'6" 168 247 112
5'7" 170 254 115
5'8" 173 262 119
5'9" 175 270 122
5'10" 178 278 126
5'11" 180 286 130
6'0" 183 294 133
6'1" 185 302 137
6'2" 188 310 141
6'3" 191 318 144
6'4" 193 326 148
6'5" 196 334 151
6'6" 198 342 155
6'7" 201 350 159
6'8" 203 358 162
6'9" 206 366 166
Yes
No
2. In the past twelve (12) months, have you lost more than 10% of your current body weight (other than due to pregnancy, intentional dieting or exercise)?
Yes
No
3. Are you currently:
  • a. Admitted to a hospital?
  • b. Residing or are you on a waiting list to reside in a long-term care facility, nursing home, skilled nursing facility or any other facility requiring care of a skilled staff?
Yes
No
4. Are you aware of any signs, symptoms, or any abnormal diagnostic test for which:
  • a. You have not yet consulted a physician?
  • b. You are currently being investigated?
  • c. You have a pending consultation with a medical specialist? (Medical specialist does not include a general practitioner and pending consultation does not mean a routine follow-up.)
  • d. You have consulted with a medical specialist without having received a diagnosis?
  • e. You are currently awaiting surgery (other than day surgery/outpatient surgery)?
Yes
No
5. Have you ever:
  • a. Been diagnosed with, hospitalized for, or undergone treatment (including medication) for cystic fibrosis, HIV, AIDS, or AIDS-related complex?
  • b. Been diagnosed with or undergone treatment (including medication) for muscular dystrophy, Huntington’s disease, amyotrophic lateral sclerosis (Lou Gehrig’s disease), Alzheimer’s disease, or dementia?
  • c. Been advised by a physician that you have a terminal illness for which are currently receiving Palliative or Hospice care or have discussed this type of care with a health professional?
Yes
No
6. Do you have a biological family member (father, mother, brother, sister), who was diagnosed With Huntington’s disease or polycystic kidney disease, and for which you have not been investigated for these diseases?
Yes
No
7. In the past ten (10) years, have you:
  • a. Received a bone marrow transplant or an organ transplant (other than a corneal transplant) or were you advised that one was required?
  • b. Been diagnosed with or hospitalized for congestive heart failure or cardiomyopathy?
Yes
No
8. In the past five (5) years, have you been diagnosed with or hospitalized for:
  • a. Chronic kidney disease or polycystic kidney disease (PKD) or undergone dialysis?
  • b. Angina or a heart attack or undergone coronary angioplasty (with or without a stent insertion) or coronary artery bypass surgery?
  • c. A cerebrovascular accident (stroke)?
Yes
No
9. In the past five (5) years, have you been diagnosed with, hospitalized for, or undergone treatment (including medication) for leukemia or cancer (other than basal cell carcinoma)?
Yes
No
10. Have you ever been diagnosed with diabetes (other than gestational diabetes) AND had any of the following conditions in the past five (5) years:
  • a. Heart attack?
  • b. Angina?
  • c. Stroke?
  • d. Peripheral vascular disease (a circulation disorder)?
  • e. Gangrene?
  • f. Amputation?
  • g. Hypoglycemic coma?
Yes
No
11. In the past ten (10) years, you have you been diagnosed with a chronic respiratory disorder (other than sleep apnea) that required the administration of oxygen?
Yes
No
12. In the past two (2) years, have you been:
  • a. Hospitalized for any respiratory disorder?
  • b. Treated with oral Prednisone or other oral corticosteroid for any respiratory disorder?
Yes
No
13. In the past five (5) years, have you been diagnosed with or hospitalized for:
  • a. Hepatitis B or C?
  • b. Cirrhosis of the liver?
  • c. Chronic pancreatitis?
  • d. Two (2) or more episodes of acute pancreatitis?
Yes
No
14. In the past three (3) years, have you been diagnosed with, hospitalized for, or undergone treatment (including medication) for any of the following conditions:
  • a. Convulsions, epilepsy, transient ischemic attack (TIA or mini-stroke), a spinal cord or brain tumor?
  • b. Bipolar disorder, schizophrenia or psychosis?
  • c. Multiple sclerosis or Parkinson’s disease?
  • d. Rheumatoid arthritis or paralysis?
  • e. Heart murmur or arrhythmia?
  • f. Crohn’s disease or ulcerative colitis?
  • g. Glomerulonephritis, scleroderma or SLE (Systemic Lupus Erythematosus)?
Yes
No
15. Is your driver’s license currently suspended or revoked as a result of any driving infractions?
Yes
No
16. In the past three (3) years, have you:
  • a. Used narcotics, barbiturates or steroids (other than prescribed by a physician)?
  • b. Used any drugs (other than marijuana products), including but not limited to cocaine, LSD, amphetamines, hallucinogens?
  • c. Used any prescribed or non-prescribed marijuana products more than 6 times per week?
  • d. Been advised by a health professional to discontinue your consumption of alcohol or drugs, or have you received advice or treatment (including medication) for alcohol or drug abuse?
  • e. Been accused or charged with alcohol-related or a drug-related driving offence or refused a breathalyzer?
  • f. Been incarcerated, convicted of a crime or violation of any law, or are you currently accused of a crime or violation of any law for which a verdict has not yet been rendered?
Yes
No
17. In the next twelve (12) months, do you expect or plan to travel outside North America, the Caribbean or Western Europe for more than twelve (12) weeks (In case you have the intention to travel to Haiti, the answer should be Yes)?
Yes
No
18. In the next twelve (12) months, do you expect or plan to engage in any hazardous sports or activities, or aerial flights other than as a passenger, commercial pilot, or crew member of a commercial flight?
Yes
No
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Eligibility Assessment Part 2

(Platinum Plans. Maximum Coverage Amount $250,000)
1. Have you ever been diagnosed with diabetes (other than gestational diabetes) AND ever had any of the following conditions:
  • a. Heart attack?
  • b. Angina?
  • c. Stroke?
  • d. Peripheral vascular disease (a circulation disorder)?
  • e. Gangrene?
  • f. Amputation?
  • g. Hypoglycemic coma?
Yes
No
2. In the past ten (10) years, have you been diagnosed with or hospitalized for:
  • a. Hepatitis B or C?
  • b. Cirrhosis of the liver?
  • c. Chronic pancreatitis?
  • d. Two (2) or more episodes of acute pancreatitis?
Yes
No
3. In the past five (5) years, have you been diagnosed with, hospitalized for, or undergone treatment (including medication) for any of the following conditions:
  • a. Convulsions, epilepsy, transient ischemic attack (TIA or mini-stroke), a spinal cord or brain tumor?
  • b. Bipolar disorder, schizophrenia or psychosis?<.li>
  • c. Multiple sclerosis or Parkinson’s disease?
  • d. Rheumatoid arthritis or paralysis?
  • e. Heart murmur or arrhythmia?
  • f. Crohn’s disease or ulcerative colitis?
  • g. Glomerulonephritis, scleroderma or SLE (Systemic Lupus Erythematosus)?
Yes
No
4. In the past three (3) months, have you required a new medication for high blood pressure or an increase in the dosage of any medication for high blood pressure?
Yes
No
5. In the next twelve (12) months, do you expect or plan to travel outside North America, the Caribbean or Western Europe for more than six (6) weeks (In case you have the intention to travel to Haiti, the answer should be Yes)?
Yes
No
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Eligibility Assessment Part A

1. Are you currently incapable of independently carrying out two or more of the basic activities of daily living such as getting up, walking, washing, toileting, dressing or feeding?
Yes
No
2. Are you currently a resident of a long-term care facility, nursing home, nursing facility, or assisted living residence?
Yes
No
3. Are you in need of an organ transplant, on a waiting list for an organ transplant or the recipient of an organ transplant (excluding corneal transplants)?
Yes
No
4. Within the past 30 days, have you been admitted to a hospital for more than 48 hours (excluding pregnancy)?
Yes
No
5. Within the past 60 days, have you been advised by a physician:
a. Of any abnormal diagnostic tests?
Yes
No
b. To have surgery or a diagnostic test or special test of any type?
Yes
No
c. To consult with a physician, medical institution or specialist that has not yet been completed?
Yes
No
6. Have you ever been diagnosed with a life threatening, critical or terminal condition for which a physician has estimated that you have 24 months or less to live?
Yes
No
7. Have you ever had, been told you have, or been treated for Acquired Immunodeficiency Syndrome (AIDS) or have you ever tested positive for Immunodeficiency virus (HIV)?
Yes
No
8. Within the past ten years, have you had, been told you have, been treated for, or been advised to have an investigation, that has not yet been completed, for:
a. Metastatic cancer or more than one occurrence of cancer (excluding basal cell carcinoma)?
Yes
No
b. Cystic Fibrosis or a chronic respiratory condition (excluding sleep apnea) which required the continuing administration of oxygen?
Yes
No
c. Dementia, Alzheimer's, Muscular Dystrophy, Huntington's Chorea or Amyotrophic Lateral Sclerosis (ALS)?
Yes
No
d. Congestive heart failure or cardiomyopathy?
Yes
No
9. Have you ever had, been treated for, or been diagnosed prior to age 40, with: chronic kidney disease, stroke (CVA), transient ischemic attack (TIA), aneurysm, coronary artery disease, heart bypass surgery, angioplasty, stent insertion, angina or heart attack?
Yes
No
10. Within the past 12 months, have you used narcotics or barbiturates (except as prescribed by a physician), heroin, psychoactive drugs, cocaine, crack or other similar agents, or been a resident of a drug or alcohol treatment facility?
Yes
No
11. Within the past 12 months, have you been convicted of, awaiting sentencing for, incarcerated for, or on probation for a criminal offence; or do you currently have any criminal charges pending?
Yes
No
12. Is your weight greater than that indicated for your height in the following table?
Yes
No
Height Weight
4'8" - 4'10" 142 - 147 cm 230 lbs 104 kg
4'11" - 5'1" 148 - 155 cm 247 lbs 112 kg
5'2" - 5'4" 156 - 163 cm 273 lbs 124 kg
5'5" - 5'7" 164 - 170 cm 300 lbs 136 kg
Height Weight
5'8" - 5'10" 171 - 178 cm 328 lbs 149 kg
5'11" - 6'1" 179 - 185 cm 358 lbs 162 kg
6'2" - 6'4" 186 - 193 cm 389 lbs 176 kg
6'5" - 6'7" 194 - 201 cm 420 lbs 191 kg
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Eligibility Assessment Part B

(Deferred Life Plan. Maximum Coverage Amount $75,000)
1. Within the past 12 months, have you had, been told you have, or been treated for:
a. Cardiac chest pain (angina), heart attack (myocardial infarction), coronary artery disease, stroke (CVA), heart bypass surgery, angioplasty, stent insertion or more than one transient ischemic attack (TIA)?
Yes
No
b. Circulatory problems in the legs and/or feet (peripheral arterial or vascular disease)?
Yes
No
c. Chronic kidney disease, or been investigated or been advised to be investigated for polycystic kidney disease (PKD), or have a family history of PKD and have not been investigated?
Yes
No
d. Liver disease such as, but not limited to, cirrhosis or hepatitis (excluding Hepatitis A or B)?
Yes
No
e. Cancer including, but not limited to, leukemia and lymphoma (excluding basal cell carcinoma)?
Yes
No
2. Are you under age 30 and have been diagnosed with diabetes (excluding gestational diabetes) or are undergoing investigation for diabetes or your blood sugar levels?
Yes
No
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Eligibility Assessment Part C

(Deferred Elite Plan. Maximum Coverage Amount $350,000)
1. Within the past 12 months, have you had, been told you have, or been treated for: bipolar disorder, schizophrenia or psychosis?
Yes
No
2. Within the past three years, have you been treated for or received medical advice or counseling for the use of drugs or alcohol?
Yes
No
3. Within the past three years, have you used narcotics or barbiturates (except as prescribed by a physician), heroin, psychoactive drugs, cocaine, crack or other similar agents?
Yes
No
4.
a. Are you age 54 or under and within the past three years, have you had treatment or surgery for or been diagnosed as having cardiac chest pain (angina), heart attack (myocardial infarction), coronary artery disease, heart bypass surgery, angioplasty, stent insertion, stroke (CVA) or chronic lung disease (excluding asthma)?
Yes
No
b. Are you age 55 or over and within the past two years, have you had treatment or surgery for or been diagnosed as having cardiac chest pain (angina), heart attack (myocardial infarction), coronary artery disease, heart bypass surgery, angioplasty, stent insertion, stroke (CVA) or chronic lung disease (excluding asthma)?
Yes
No
5. Are you under age 55 with diabetes that was diagnosed more than 20 years ago and is currently treated with insulin?
Yes
No
6. Do you have diabetes that is currently treated with insulin and the prescribed dosage of insulin increased within the past six months?
Yes
No
7. Have you ever had, been told you have, or been treated for diabetes and any of the following: coronary artery disease, peripheral vascular disease, tingling and loss of feeling in the extremities (neuropathy), amputation, retinopathy or stroke (CVA)?
Yes
No
8. Within the past three years have you had, been told you have, or been treated for:
a. Lung cancer?
Yes
No
b. Colon cancer?
Yes
No
c. Breast cancer, cervical cancer or uterine cancer?
Yes
No
d. Malignant melanoma?
Yes
No
e. Leukemia (all types), lymphoma or multiple myeloma?
Yes
No
9. Do you plan to travel outside North America, the Caribbean (excluding Haiti), the United Kingdom or the European Union countries for more than 12 consecutive weeks in the next 12 months?
Yes
No
10. Have you had a weight loss of 10% of body weight or more within the past 12 months other than due to intentional dieting?
Yes
No
11. Is your weight outside the range shown for your height in the following table?
Yes
No
Height Male Weight Male
4'8" - 4'10" 142 - 147 cm 79 - 185 lbs 36 - 84 kg
4'11" - 5'1" 148 - 155 cm 87 - 199 lbs 39 - 90 kg
5'2" - 5'4" 156 - 163 cm 94 - 215 lbs 43 - 98 kg
5'5" - 5'7" 164 - 170 cm 104 - 235 lbs 47 - 107 kg
Height Male Weight Male
5'8" - 5'10" 171 - 178 cm 115 - 260 lbs 52 - 118 kg
5'11" - 6'1" 179 - 185 cm 125 - 282 lbs 57 - 128 kg
6'2" - 6'4" 186 - 193 cm 139 - 305 lbs 63 - 138 kg
6'5" - 6'7" 194 - 201 cm 149 - 333 lbs 68 - 151 kg
Height Female Weight Female
4'8" - 4'10" 142 - 147 cm 74 - 181 lbs 33 - 81 kg
4'11" - 5'1" 148 - 155 cm 82 - 194 lbs 36 - 87 kg
5'2" - 5'4" 156 - 163 cm 89 - 210 lbs 40 - 95 kg
5'5" - 5'7" 164 - 170 cm 99 - 230 lbs 44 - 104 kg
Height Female Weight Female
5'8" - 5'10" 171 - 178 cm 110 - 255 lbs 49 - 115 kg
5'11" - 6'1" 179 - 185 cm 120 - 277 lbs 54 - 125 kg
6'2" - 6'4" 186 - 193 cm 134 - 300 lbs 60 - 135 kg
6'5" - 6'7" 194 - 201 cm 144 - 328 lbs 65 - 148 kg
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Eligibility Assessment Part 1

1. In your lifetime, have you been diagnosed and/or treated for any of the following conditions:
a. Acquired immunodeficiency syndrome (AIDS) or tested positive for the human immunodeficiency virus (HIV)?
Yes
No
b. Heart rhythm disorder (arrhythmias) which required the insertion of a pacemaker, heart failure or cardiomyopathy?
Yes
No
c. Cystic fibrosis, Alzheimer’s disease, dementia, Huntington’s chorea, Parkinson’s disease, amyotrophic lateral sclerosis (Lou Gehrig’s disease), muscular dystrophy, myotonic dystrophy or any form of ataxia?
Yes
No
d. Chronic respiratory disease (excluding sleep apnea) which requires the daily administration of oxygen?
Yes
No
e. For individuals less than 18 years of age, type-1 diabetes, cerebral palsy, any congenital heart disease, Down’s syndrome or autism spectrum disorder (ASD)?
Yes
No
2. Within the last three (3) years, have you had or been treated for leukemia, lymphoma, malignant tumour or any form of cancer (other than basal cell carcinoma)?
Yes
No
3. Within the last twelve (12) months:
a. Have you been found guilty of a criminal offence (including offences associated with driving under the influence – DUI) or of a criminal offence awaiting trial?
Yes
No
b. Have you used any hard drugs except as prescribed by a physician or have you used methadone prescribed or not by a physician?
Yes
No
4. Are you presently:
a. Hospitalized or in a nursing facility including a centre or a home for individuals with reduced autonomy?
Yes
No
b. Bedridden or wheelchair bound?
Yes
No
c. Undergoing or waiting for an investigation for diagnostic purposes?
Yes
No
5. For individuals 15 years of age or older, is your weight greater than the weight corresponding to your height in the following table?
Yes
No
Height/Ft Weight/Lbs Height/Meters Weight/Kg
4'8" - 4'10" 230 1.42 - 1.49 cm 105
4'11" - 5'1" 260 1.50 - 1.56 cm 118
5'2" - 5'4" 285 1.57 - 1.64 cm 129
5'5" - 5'7" 310 1.65 - 1.72 cm 141
5'8" - 5'10" 335 1.73 - 1.79 cm 152
5'11" - 6'1" 365 1.8 - 1.87 cm 165
6'2" - 6'4" 390 1.88 - 1.95 cm 177
6'5" - 6'7" 415 1.96 - 2.01 cm 188
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Eligibility Assessment Part 2

(Deferred Plus. Maximum Coverage Amount $350,000)
1. For individuals 15 years of age or older, is your weight greater than the weight corresponding to your height in the following table?
Yes
No
Height/Ft Weight/Lbs Height/Meters Weight/Kg
4'8" - 4'10" 190 1.42 - 1.49 cm 86
4'11" - 5'1" 200 1.50 - 1.56 cm 91
5'2" - 5'4" 220 1.57 - 1.64 cm 100
5'5" - 5'7" 240 1.65 - 1.72 cm 109
5'8" - 5'10" 260 1.73 - 1.79 cm 118
5'11" - 6'1" 280 1.8 - 1.87 cm 127
6'2" - 6'4" 300 1.88 - 1.95 cm 136
6'5" - 6'7" 330 1.96 - 2.01 cm 149
2. Within the last five (5) years:
a. Have you had an amputation as a result of a disease?
Yes
No
b. Have you had or been treated for a chronic kidney disease or a chronic liver disease (including cirrhosis, fibrosis, hepatitis C or any other types of chronic hepatitis)?
Yes
No
c. Have you received an organ transplant or a bone marrow transplant or were you advised to do so due to your condition?
Yes
No
d. Have you been treated for drug or alcohol use, joined a support group or been advised to reduce your consumption or to receive treatment for it?
Yes
No
3. Within the last three (3) years:
a. With regards to heart attack (myocardial infarction), angina or heart valve disease:
l. Have you been diagnosed and/or been treated with anticoagulants?
Yes
No
ll. Have you undergone a surgery (including bypass, angioplasty or insertion of a stent or prosthesis) or are you awaiting such surgery?
Yes
No
b. With regards to cerebrovascular disease (stroke), transient ischemic attack (TIA) or vascular disease of the arms and/or legs (excluding varicose veins and superficial phlebitis):
l. Have you been diagnosed and/or been treated with anticoagulants?
Yes
No
ll. Have you had or are you awaiting surgery?
Yes
No
4. Within the last twelve (12) months:
a. With regards to depression or any mental health disorder:
l. Have you been hospitalized?
Yes
No
ll. Has your medication been changed (addition or replacement of a medication, increase or decrease of dosage)?
Yes
No
lll. Have you ceased your medication without being advised by your doctor to do so?
Yes
No
b. Have you undergone a surgery for an aneurysm or are you awaiting such surgery?
Yes
No
c. If you have diabetes, has your medication changed as advised by a physician (addition or replacement of a medication, increase or decrease of dosage)?
Yes
No
NEXT

Eligibility Part 3

(Immediate Plus. Maximum Coverage Amount $500,000)
1. Within the last five (5) years, have you had or been treated for leukemia, lymphoma, malignant tumour or any form of cancer (other than basal cell carcinoma)?
Yes
No
2. Within the last twelve (12) months, has your weight decreased by 10% or more (excluding after a diet or childbirth)?
Yes
No
3. Within the next two (2) years:
a. Do you foresee travelling to high risk regions or regions of conflict or war? If not sure, please consult the list of countries classified "Avoid all travel" or "Avoid non-essential travel" on the official Government of Canada website: https://travel.gc.ca/travelling/advisories
Yes
No
b. Do you intend to reside outside Canada or the USA for at least six (6) consecutive months?
Yes
No
4. Family history: Has a member of your immediate family (father, mother, brother or sister) been diagnosed with any of the following conditions:
a. Huntington’s disease or polycystic kidney disease before age 60?
Yes
No
b. For individuals less than 3 years of age, cystic fibrosis?
Yes
No
NEXT

Now let’s start your Assumption Life application!

Your Application will take approximately 10-12 minutes
1. What is your full name?
2. Your address
Apartment Number
City/Town
Province/Territory
Postal Code
Social Insurance Number
*Only for Whole life
P.O Box
3. Present residency status in Canada
Canadian citizen
Permanent resident(landed immigrant)
Other (specify)
4. What is your Country of Birth?
5. What is your Province/Territory of Birth? (If your country of birth is outside Canada, type N/A).
6. What is your occupation?
7. Select ID Type
Province/Territory
Other (Specify)
ID Number
Expiry Date
8. Is the insurance requested intended to replace an existing individual life insurance?
Yes
No
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1
2
3

Now let’s start your IA Financial application!

Your Application will take approximately 10-12 minutes
1. What is your full name?
2. Your address
Apartment Number
City/Town
Province/Territory
Postal Code
P.O Box
3. What is your Social Insurance Number (SIN)?
*Only for Whole life
4. Do you have other pending insurance applications?
Yes
No
5. Have you ever been declined for insurance?
Yes
Life
Critical Illness
Disability
No
6. Do you have in-force insurance on your life, excluding group insurance or credit insurance?
Yes
Surrender of contract?
Yes, surrender of contract
No, not a surrender of contract
Personal
Business
No
7. When was the last time you used tobacco in any form (including cigarettes, cigars, cigarillos, marijuana/cannabis mixed with tobacco, electronic cigarettes, gum, patches, chewing tobacco or snuff, betel nuts, shishas, hookah/water pipe, etc.)?
Never
Between 1 and 3 years ago
Between 3 and 5 years ago
More than 5 years ago
In the past year, specify
Cigarettes
Cigarillos
Electronic cigarettes
Gum or nicotine patches
Cigars
Marijuana/cannabis mixed with tobacco
Other tobacco or nicotine products (chewing tobacco or snuff, betel nuts, shisha, hookah/water pipe, etc.)
8. Were you born in Canada?
Yes
No
a. What is your country of birth?
b. Have you lived in Canada at least 3 years?
I have
I have not
a. Have you lived in Canada at least one year?
I have
I have not
b. What is your legal status?
Canadian citizen
Permanent resident
Work Permit (other than seasonal worker)
Officially accepted Convention refugee
Other
9. What is your completed level of education?
No diploma
Apprenticeship Program
Undergraduate Certificate
Postgraduate Degree
High school or equivalent
College
Bachelor's Degree
10. What is your occupation?
Sector of occupation
Military
Construction
Marine transportation (outside Canada)
Natural resources (forestry, mining, oil or gas industry)
Arts and entertainment (music, cinema, circus, etc.)
Professional sport (athlete)
Unemployed
Disabled
None of the above
11. Will the life insurance be financed and/or paid by a lender or any other person who has no relationship with insured person?
Yes
No
12. Is one of the applicants U.S. citizen or U.S. resident for U.S. tax purposes?
Yes
No
13. Is one of the applicants a tax resident in a jurisdiction other than Canada or United States?
Yes
No
14. Have you sought medical attention or received treatment for or been told you have symptoms of any of the following diseases or disorders?
Cerebral vascular accident/stroke (CVA)/Transient ischemic attack (TIA)
Angina/Heart attack (with or without bypass surgery/angioplasty)
Cancer/Malignant tumor (any site)
Major depression (in the last five years) or Bipolar disorder (any duration)
Diabetes
Hepatitis B or C (other than carrier)
Crohn's disease/Ulverative colitis diagnosed in the last 8 years
Chronic obstructive pulmonary disease (COPD)/Emphysema
Rheumatoid arthritis polyarthritis/Spondylarthritis
No
Yes
Have you been hospitalized or did you undergo a surgery?
I have
I have not
If you have indicated "Major depression or Bipolar", were you on disability?
Yes
No
Full name and address of the doctor(s) following you for the disease(s) or disorder(s) you disclosed:
No
 

COVID-19 (Coronavirus) Exposure Questionnaire

1. In the last 4 weeks, have you travelled outside of Canada or have you transmitted through an airport?
Yes
If yes, specify the place(s) you visited and/or transited through and date of return:
Asia
Africa
Europe
Oceania
North America
South America
No
2. Are you experiencing symptoms of fever, cough or difficulty breathing?
Yes
No
3. In the last 4 weeks, have you or someone close to you been in contact with a confirmed or suspected case of COVID-19 coronavirus infection?
Yes
No
4. In the last 12 months, have you been hospitalized for the COVID-19 coronavirus disease?
Yes
If yes, please provide details:
No
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Now let’s start your RBC Insurance application!

Your Application will take approximately 10-12 minutes
1. What is your full name?
2. Your address
Apartment Number
City/Town
Province/Territory
Postal Code
3. Present residency status in Canada
Canadian citizen
Permanent resident
Other (specify)
4. How long have you resided in Canada?
5. Birthplace: Country
6. Employment/Business Information
a. Business/Employer Name
b. Business/Employer Address: Suite No.
c. Street
d. Province
e. Postal Code
f. City
g. Phone No.
h. Occupation
i. Describe nature of business
j. Describe duties
k. How long with this employer?
7. Main purpose of insurance
Personal
Income Replacement
Estate Conservation
Other
Business
Protect key personnel
Fund buy-sell agreement
Other business
8. Have You applied for life, critical illness or disability insurance concurrently with this Application or within the past 12 months with any other company?
Yes
Life
Critical Illness
Disability
No
9. What is Your annual earned income from employment in Canadian dollars?
10. What is Your estimated net worth in Canadian dollars?
11. If not self supporting, what is the annual gross amount of the family earned income?
12. What is Your annual income in Canadian dollars from other sources?
13. Amount of mortgage outstanding on personal residence and/or cottage?
14. Describe “other sources” of income
15. Have You within the past 5 years declared personal or corporate bankruptcy?
Yes
No
16. Have You collected EI (Employment Insurance), disability benefits, workers’ compensation benefits, CPP or QPP disability benefits, income replacement benefits, or any form of social assistance in the past 12 months?
Yes
EI
Disability
WCB
Other
No
17. Have You within the past 24 months been a student pilot, or piloted a plane, ultra-light or glider, or do You have any intention of doing so in the future?
Yes
No
18. Select ID Type
Province/Territory
ID Number
Expiry Date
19. Do You have any Life coverages in force or pending, including any with RBC Life?
Yes
Personal
Business
Is the insurance applied for intended to replace any insurance now in force with any company?
Yes
No
No
20. Have You within the past 12 months traveled outside Canada or the United States of America, or do You intend to do so within the next 12 months?
Yes
No
21. Have You within the past 24 months engaged in any hazardous or contact sports or activities, including but not limited to racing, scuba diving deeper than 100ft (30m), skydiving, heli-skiing or back-country skiing, or do You intend to do so?
Yes
No
22. Have You ever had life, disability or critical illness insurance rated, modified, rejected, rescinded, or have You been denied renewal or reinstatement?
Yes
Rated
Modified
Rejected
Rescinded
Denied Renewal or Reinstatement
No
23. Have You within the past 10 years been convicted of any criminal offence, or are there any such charges pending?
Yes
No
24. Have You within the past 10 years been convicted of any driving offences or violations, including impaired driving, and/or have You had a driver’s license revoked or suspended, or are any such charges pending?
Yes
No
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Now let’s start your Assumption Life application!

Your Application will take approximately 8-10 minutes
1. What is your full name?
2. Your address
Apartment Number
City/Town
Province/Territory
Postal Code
Social Insurance Number
*Only for Whole life
3. Present residency status in Canada
Canadian citizen
Permanent resident(landed immigrant)
Other (specify)
4. What is your Country of Birth?
5. What is your Province/Territory of Birth?
6. What is your occupation?
7. Select ID Type
Province/Territory
Other (Specify)
ID Number
Expiry Date
8. Is the insurance requested intended to replace an existing individual life insurance?
Yes
No
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Now let’s start your CPP application!

Your Application will take approximately 8-10 minutes
1. What is your full name?
2. Your address
Apartment Number
City/Town
Province/Territory
Postal Code
Social Insurance Number
*Only for Whole life
3. Present residency status in Canada
Canadian citizen
Permanent resident
Work Permit/Study Permit
4. What is your country of birth?
5. What is your occupation?
6. Select ID Type
Province/Territory
ID Number
Expiry Date
7. Are you a U.S. resident for tax purposes, or a U.S. citizen, and/or a resident of another country?
Yes
No
8. Will premiums be stopped, or coverage be reduced or discontinued, on any existing life insurance coverage or annuity if the insurance applied for in this application is issued?
Yes
No
9. Physician Information
 

COVID-19 (Coronavirus) Exposure Questionnaire

1. Have you experienced any of the following signs or symptoms within the last 14 days? (Fever, persistent cough that has not subsided, shortness of breath, flu-like fatigue, sore throat, nausea, vomiting and/or diarrhea and/or loss of smell or taste)
Yes
If YES - Check all that apply and additional details.
Fever
Persistent cough that has not subsided
Shortness of breath
Flu-like fatigue
Sore throat
Nausea, vomiting and/or diarrhea
Loss of smell or taste
No
2. Have you been advised to be tested for Coronavirus (COVID-19), or are you or have you been in close contact with anyone who has been quarantined for or diagnosed with Coronavirus (COVID-19)?
Yes
If YES - Please provide details including test result and date of exposure.
No
3. In the past 21 days have you returned from travel abroad?
Yes
If YES - Please advise date of return to Canada.
No
4. Are you currently in good health, in relation to COVID-19?
Yes
No
If NO - Please provide details.
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Now let’s start your IA Financial application!

Your Application will take approximately 8-10 minutes
1. What is your full name?
2. Your address
Apartment Number
City/Town
Province/Territory
Postal Code
Social Insurance Number
*Only for Whole life
P.O Box
3. When was the last time you used tobacco in any form (including cigarettes, cigars, cigarillos, cannabis (marijuana) mixed with tobacco, electronic cigarettes, gum, patches, chewing tobacco or snuff, betel nuts, shishas, hookah / water pipe, etc.)?
Never
In the past year,specify:
Cigarettes
Cigarillos
Electric cigarettes
Gum or nicotine patches
Cigars
Cannabis (marijuana) mixed with tobacco
Other tobacco or nicotine products (chewing tobacco or snuff, betel nuts,shisha, hookah / water pipe, etc.
Between 1 and 3 years ago
Between 3 and 5 years ago
More than 5 years ago
4. What is your occupation?
5. Is one of the applicants U.S. citizen or U.S. resident for U.S. tax purposes?
Yes
No
6. Is one of the applicants a tax resident in a jurisdiction other than Canada or United States?
Yes
No
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Back

Now let’s start your IA Financial application!

Your Application will take approximately 10-12 minutes
1. What is your full name?
2. Your address
Apartment Number
City/Town
Province/Territory
Postal Code
P.O Box
3. What is your Social Insurance Number (SIN)?
*Only for Whole life
4. Do you have other pending insurance applications?
Yes
No
5. Have you ever been declined for insurance?
Yes
Life
Critical Illness
Disability
No
6. Do you have in-force insurance on your life, exluding group insurance or credit insurance?
Yes
Surrender of contract?
Yes
No
Personal
Business
No
7. When was the last time you used tobacco in any form (including, cigarettes, cigars, cigarettes, cigarillos, cannabis (marijuana) mixed with tobacco, electronic cigarettes, gum, patches, chewing tobacco or snuff, betel nuts, shishas, hookah/water pipe, etc.)?
Never
Between 1 and 3 years ago
Between 3 and 5 years ago
More than 5 years ago
In the past year, specify:
Cigarettes
Cigarillos
Electric cigarettes
Gum or nicotine patches
Cigars
Cannabis (marijuana) mixed with tobacco
Other tobacco or nicotine products (chewing tobacco or snuff, betel nuts,shisha, hookah / water pipe, etc.
8. Were you born in Canada?
Yes
No
Have you lived in Canada at least 3 years?
Yes
No
Have you lived in Canada at least one year?
Yes
No
What is your legal status?
Canadian Citizen
Permanent resident
Work Permit(other than seasonal worker)
Officialy accepted Convensional refugee
Other
Specify other legal status
9. What is your completed level of education?
No diploma
Apprenticeship Program
Undergraduate Certificate
Postgraduate Degree
High school or equivalent
College
Bachelor's Degree
10. What is your occupation?
11. Select ID Type
Province/Territory
ID Number
Expiry Date
12. Will the life insurance be financed and/or paid by a lender or any other person who has no relationship with insured person?
Yes
No
13. Is one of the applicants U.S. citizen or U.S. resident for U.S. tax purposes?
Yes
No
14. Is one of the applicants a tax resident in a jurisdiction other than Canada or United States?
Yes
No
Next
Back

Now let’s start your CPP application!

Your Application will take approximately 8-10 minutes
1. What is your full name?
2. Your address
Apartment Number
City/Town
Province/Territory
Postal Code
Social Insurance Number
*Only for Whole life
3. Present residency status in Canada
Canadian citizen
Pernament resident
Work Permit/Study Permit
4. What is your Country of Birth?
5. What is your occupation?
6. Select ID Type
Province/Territory
ID Number
Expiry Date
7. Are you a U.S. Resident for tax purposes, or a U.S. citizen, and/or a resident of another country?
Yes
No
8. Within the past 12 months, have you used by any means, a substance or product containing tobacco or nicotine (excluding cigars), or have you smoked (including electronic vaporizer or “vaping”) marijuana more than four times per week?
Yes
No
9. Will premiums be stopped, or coverage be reduced or discontinued, on any existing life insurance coverage or annuity if the insurance applied for in this application is issued?
Yes
No
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Beneficiary Information

Beneficiary Last Name
Beneficiary First Name
Relationship to Insured
Date of Birth
Share percentage, %
Beneficiary Type
Revocable
If revocable, you can change who your beneficiary is anytime without getting their consent.
Irrevocable
Irrevocable, on the other hand, means that if you want to change your beneficiary you actually need their consent to do so.
Beneficiary is
Primary
Primary: the person, people or entity you choose to receive the death benefits.
Contingent
Contingent: the person, people or entity you designate to receive the death benefits if all of the primary beneficiaries die before you.
Beneficiary Gender
Male
Female

A beneficiary under the age of 18 is considered a minor. A trustee must be named to serve the purpose of receiving the funds on the minor's behalf until the named beneficiary reaches the age of majority.
*Applicable in all provinces, except Quebec.

Trustee First Name
Trustee Last Name
Relationship to Owner
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Banking Information

1. Premium Details
Premium payment frequency
Annual
Monthly (PAD) Pre-Authorized Debit

Pre-Authorized Debit (PAD) Plan Agreement

Monthly Withdrawals under this PAD Agreement are
Personal related
Business related
Withdrawal date requested (1st - 28th)
Type of Account
Chequing
Savings
Transit # (5 digits)
Account # (7-12 digits)
Name of Financial Institution
Financial Institution #
(3 digits)
What city are you currently located in?
What province are you currently located in?
2. What is your primary telephone number?
3. What is your email?
REVIEW APPLICATION
Clicking this button redirects you to DocuSign. Here, you will be able to view, or download, your official application and provide your electronic signature. Your bank account will not be charged until the Docusign portion is signed.
Your Application Has Been Successfully Submitted
Congratulations! You’ve taken your first steps towards getting covered. Your application is now in underwriting with the Insurer, if required will be in touch with any medical requirements that are needed. If you have any questions, please call us at: 1-877-574-7475