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CRITICAL ILLNESS QUOTE

FOR EXISTING CLIENTS ONLY

Fields with an asterisk * are required to complete the quote

General Information

pounds

feet

inches

Have you been treated or taken medication for any of the following conditions within the past 10 years:

The following information can help us provide you with the most accurate quote.

Is your Blood Pressure above 140/85?
What is your Cholesterol Count?
Have you been a pilot or airline crew member in the past 3 years?
Have you had more than 3 moving traffic violations in the past 3 years?
Have you ever been convicted of a DUI?
Before the age of 60, has anyone in your immediate family (siblings and parents) been diagnosed with cancer, diabetes, or heart or kidney disease?

Insurance Needs

Select the amount of insurance needed for this quote.
Payment Mode:

(Note that insurance carriers will typically charge a nominal surcharge for the Quarterly or Semi-annual Payment Modes)

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First Rate Insurance Inc. © 2016
The product pricing and details of this coverage and any other coverage on this website may vary and/or change as per the underwriting insurance companies discretion and are not guaranteed. First Rate Insurance Inc. only represents the said underwriting insurance companies coverage(s) and in no way is responsible for the actions or errors that may occur from such said underwriting insurance companies. Further, the product pricing and information supplied is not intended to nor should be understood to make any recommendations as to the suitability of any and all products shown in this website. We strive to maintain the accuracy with all the information provided on this website; but we can not and do not guarantee the validity or accuracy of any of the information provided or displayed. Recommended plans are underwritten by Industrial Alliance and Lloyd's Underwriters and administered by TUGO a registered trademark and is administered by North American Air Travel Insurance Agents Ltd under Licence #LIC-9002198C111910R2.