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Enter Client Information
The first 3 characters of your
Canadian postal code:
Birthdate:
January
February
March
April
May
June
July
August
September
October
November
December
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
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1977
1978
1979
1980
1981
1982
1983
1984
1985
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1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
Gender:
Male
Female
Smoker/Tobacco:
Yes
No
Health Class:
Preferred Plus
Preferred
Regular Plus
Regular
Type of Insurance:
5 Year Guaranteed
10 Year Guaranteed
15 Year Guaranteed
20 Year Guaranteed
25 Year Guaranteed
30 Year Guaranteed
to age 65 Guaranteed
to age 70 Guaranteed
to age 75 Guaranteed
10 vs 20 Year Term
20 vs 30 Year Term
10 vs 15 vs 20 Yeart Term
10 vs 20 vs 30 Year Term
All Term Product Categories
Face Amount:
$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
$750,000
$800,000
$900,000
$1,000,000
$1,250,000
$1,500,000
$1,750,000
$2,000,000
$2,500,000
$3,000,000
$5,000,000
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