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Critical Illness Insurance Quote
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Critical Illness Insurance Quote
admin@ottawa
2023-07-24T12:06:13-04:00
Get a Critical Illness quote
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About you
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Name
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First
Last
Email
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Phone
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Address
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City
Province
Postal Code
Date of birth
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Month
Day
Year
Gender (at birth)
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Male
Female
Height (Feet-inches)
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Weight (lbs)
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Do you smoke or use tobabacco?
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No
Yes
Ever been declined for insurance?
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No
Yes
Ever been treated for
AIDS/HIV
Alcohol/Drugs
Asthma
Cancer
Cholesterol
Depression
Diabetes
Heart Disease
Hypertension
Kidney Disease
Liver Disease
Mental Illness
Stroke
Ulcers
Other
Please specify
Initial Level Insurance Period
Term 10 Year
Term 20 Year
Till Age 65
Term to 100
Amount of Insurance
$25,000
$50,000
$75,000
$100,000
$150,000
$200,000
$250,000
$300,000
$350,000
$400,000
$450,000
$500,000
$600,000
$700,000
$800,000
$900,000
$1,000,000
$1,250,000
$1,500,000
Other
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