iA Financial Application

Fastest Underwriting!

iA Financial Application

Step 1 of 9

Hidden
Email
Hidden
Spouse Email
Hidden
First Name
Hidden
Spouse First Name
Hidden
Last Name
Hidden
Spouse Last Name
Hidden
Tag 1
Hidden
Tag 2
Hidden
Main Form ID
Information About (You)
Full Address*
Address Apt No (optional) City State / Province ZIP / Postal Code Country
Mailing Address
- Same as Above
Mailing Address*
Address Apt No (optional) City State / Province / Region ZIP / Postal Code Country
Mobile Phone Number*
Identification
Identification*
Province/Territory of Issue*
Number*
Expiry Date*
MM slash DD slash YYYY

Beneficiary`s For (You)
Primary Beneficiary(s)Your primary beneficiary(s) are first in line to receive the life insurance proceeds in the event of your death. If you have one beneficiary then they will receive 100% of the proceeds, and if you have several beneficiaries it will be split between them depending on the share percentage you choose.
Full Name*

Date of Birth*

Gender*

Relationship*

Please specify

Share %*

Would you like to be able to change the beneficiary without having his/her consent?*
Hidden
Benficiary Full Name
Hidden
Benficiary Date of Birth
Hidden
Benficiary Gender
Hidden
Benficiary Relationship
Hidden
Benficiary Specify
Hidden
Benfeficiary Share
Hidden
Benfeficiary Consent
Contingent Beneficiary(s)Your contingent beneficiary(s) are only in the event that your primary beneficiary(s) are deceased. If your primary beneficiary(s) have passed away then your contingent beneficiary(s) will receive the life insurance proceeds. If your contingent beneficiary(s) are also deceased or you didn’t name any then your estate will be the beneficiary for your life insurance proceeds and will be distributed according to your will. If you do not have a will then it will be distributed according to provincial laws which vary province to province.
Would you like to add a Contingent Beneficiary to this coverage?*
- Yes
- No
Full Name*

Date of Birth*

Gender*

Relationship*

Please specify

Share %*
Hidden
Contingent Full Name
Hidden
Contingent Gender
Hidden
Contingent Relationship
Hidden
Contingent Specify
Hidden
Contingent Share
Trustee for all minor beneficiariesIf any of your primary or contingent beneficiaries are minors you will need to add a trustee for them. In the event of your death, this trustee will manage the life insurance proceeds on behalf of the minors until they reach age of majority. Upon age of majority they will have access to the life insurance funds and any accumulated capital from investments.
Are any primary or contingent beneficiaries a minor?*
- Yes
- No
Full Name*

iA Financial Application

iA Financial Application

Step 1 of 9

Information About (You)

Insurance History for (You)

Declaration of insurability

Tobacco Use for (You)

Birthplace for (You)

Occupation for (You)

Prior Declarations for (You)

Family History for (You)

Specialists and Medication for (You)

Neurological and Mental Health for (You)

General Medical Conditions for (You)

Investigation and Build for (You)

Sports and Travel for (You)

Life Habits for (You)

Beneficiary`s For (You)

Regulatory Questions for (You)

Billing For (You)