Online Client Disclosure
By submitting your application and agreeing to the “Client Disclosure” you are bound to the conditions found herein.
I certify that this information is correct and complete to the best of my knowledge. I understand that this information will be submitted to the insurance carrier of my choice in whole or in part and Affinity Life is not responsible for any errors or mistakes on my part.
I understand and agree that files will be stored and kept electronically as required by regulatory and compliance bodies. Some third-party software used in the application process is not exclusive to Canada and the laws governing it may be different.
I understand that a needs analysis was offered to me prior to receiving life insurance quotes. If I chose to decline the needs analysis I understand that Affinity Life holds no liability for my choice of coverage amount and duration of policy.
I authorize the submission of this information to the insurance carrier of choice and understand that life insurance underwriting will occur. I agree that the application is being signed in the province in which Affinity Life is licensed.
I understand that by agreeing to this document I authorize communication between myself and Affinity Life to contact me in a timely and efficient manner including by electronic means for the purposes of this application and related reasons.
Affinity Life holds the following licenses;
- License – Life/A&S
- Sponsor – Equitable Life of Canada (10333 Southport Rd SW suite 517)
- Provinces – Alberta, British Columbia
- Mailing Address – 1550 5 St SW #300, Calgary, AB T2R 1K3
Limited Sample of Available Carriers and/or Referral Partners Affinity Life is contracted with;
- Assumption Life
- CPP (Canada Protection Plan)
- DFS (Desjardins Financial Services)
- Empire Life
- Equitable Life
- Forester’s Life
- Humania Assurance
- RBC Insurance
- iA Financial Group
- SSQ Insurance
Personal Request for Service and the Indemnification of Non-Licensed Third Parties
I acknowledge that Affinity Life may receive an initial and/or ongoing commission or referral fee on the products applied for as well as may be eligible for additional compensation, such as bonuses, and other benefits, such as conferences. Affinity Life takes the potential of a conflict of interest seriously and confirms that at the time of application there is no conflict of interest. I acknowledge that any products sold through prospectus, information folders, offering memorandums, or referral arrangements for which Affinity Life is not specifically licensed may or may not fall under Affinity Life’s Errors and Omissions insurance coverage. Disclosures outlining any commissions, fees, and/or gifts received by Affinity Life are available to me upon request. A complete listing of Affinity Life’s Outside Business Activities is also available upon my request. If there are direct conflicts of interest between the brokerage, the supplier and the client, specific disclosures will be provided. Note: Additional consent forms and disclosures may be required of me at time of application and as specific products are purchased. Affinity Life does not hold a controlling interest in any insurance carrier, nor do they hold an ownership interest in Affinity Life’s business.