Get a Free Critical Illness Quote

John Beaton

The purpose of this form is to collect sufficient information from you so that I can survey the market place to provide you with an accurate critical illness insurance quote. Please enter your information, click on the submit button once and a quote will be e-mailed to you. If you are more than 65 years of age, you are ineligible to apply for a critical illness plan. If you are applying for first time critical illness insurance for a child under the age of 18, only child type illnesses are covered. When that child reaches age 18, and wishes coverage to continue, the definition of illnesses changes to adult type illnesses. Please note that some companys offer child critical illness riders on the parent's policy.

Full Name:
Province of Residence:
Home Telephone Number:
E-mail address:
Date of Birth: Day Month Year
Gender: Male Female
Ever used tobacco? Yes No
If yes, when did you quit?
Ever used marijuana? Yes No
If yes, when did you quit?
Amount of Coverage: [minimum $25,000]
Type of Coverage: 10 year renewable coverage to age 75: Level coverage to age 75: Level coverage to age 100:
Return of Premium Rider: Return of premium on death Return of premium on maturity-expiry of policy Return of premium on surrender
If available, send sample CI policy: Yes No
If you have any questions, please use the text box below:

Submitting the above information provides you with a no obligation critical illness insurance quote within 24 hours.

You will receive no further contact unless you request it.

If you are satisfied with your quote and you wish to apply for coverage, please contact me again and arrangements will be made for completion of a confidential application for coverage. My local telephone number is 604-535-2404, toll free 1-800-667-8818 and e-mail john@beaton-insurance.com

John Beaton - Critical Illness Broker
15310 Pacific Avenue
White Rock, British Columbia, Canada V4B 1P9
Telephone: (604) 535-2404
Fax: (604) 531-4013
Toll Free Canada: 1-800-667-8818
Website: http://www.survive-it.com
E-mail: john@beaton-insurance.com