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TEST
Anticipated Needs
Salary needs per month in the event of death?
(Required)
70% of monthly income per wage earner x 12 months x 10 years.
Estimated final expenses
(Required)
Estimated bills to be paid-off
(Required)
Credit card(s), utilities, line of credit, short-term debt(s)
Children's education expense
Estimated amount you want to leave your children for their education fund.
Existing mortgage payout amount
Existing Assets
C.P.P. death benefit
(Required)
We’ve pre-filled the amount for you.
The amount of Survivors Pension that you would receive from your spouse’s C.P.P? x 12 months (CPP=Canada Pension Plan)
The amount of monthly Orphan Pension that you would receive for each child under 18, or to age 25 if attending post-secondary institution x 12?
Amount of Death Benefits from your life insurance via your group benefits
Amount of Life Isurance that you own
Amount of Mortgage Insurance on your home
Non-Regsitered savings amount
Registerd savings amount
Hidden
Your Life Insurance Needs Calculated Results
Change Request
Insurer's Name
(Required)
First
Last
Client Identification No
(Required)
Change Requested By
(Required)
Email
(Required)
Enter Email
Confirm Email
Address
(Required)
Street Address
Address Line 2
City
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Northwest Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Province
Postal Code
Phone
(Required)
Fax
Please make the following changes to my:
Life Policy
Disability Policy
Critical Illness Policy
Other
This appointment is about: (check all that apply)
Life Insurance
Disability Insurance
Critical Illness Insurance
Long-Term Care Insurance
Partnership Insurance
Mortgage Insurance
Investments
Estate & Trust Planning
Group Pensions
Group Benefits
Other
Please Specify
Effective Date of Change
(Required)
MM slash DD slash YYYY
Please describe required changes.
(Required)
Please confirm changes with me by:
(Required)
Email
Phone
Fax
Select All