RBC Application

Fastest Online Application!

Step 1 of 7

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Email
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Spouse Email
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First Name
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Spouse First Name
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Last Name
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Spouse Last Name
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Tag 1
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Tag 2
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Tag 3
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Main Form ID
Information About You
Full Address*
Address Apt No (optional) City State / Province / Region 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
Information About Spouse
Full Address*
Address Apt No (optional) City State / Province / Region 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?*
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Benficiary Full Name
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Benficiary Date of Birth
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Benficiary Gender
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Benficiary Relationship
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Benficiary Specify
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Benfeficiary Share
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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 %*
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Contingent Full Name
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Contingent Gender
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Contingent Relationship
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Contingent Specify
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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*
Beneficiary`s for (Spouse)
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?*
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Spouse Benficiary Full Name
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Spouse Benficiary Date of Birth
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Spouse Benficiary Gender
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Spouse Benficiary Relationship
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Benficiary Specify
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Benficiary Share
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Spouse 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*

Medical Questions
A telephone interviewer will call both of you to ask lifestyle and medical questions that are required for this application.
What are your preferred days and times for this call?*
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
Time*
To
Time*
Billing for (You)
The first monthly premium will not be withdrawn until 1-2 weeks AFTER the policy is approved. A monthly premium will be withdrawn on the effective date of the policy monthly. (Example: Your policy is approved on March 13th, the first premium will be withdrawn around March 28th and the next on April 13th, then May 13th and so on.)

Providing your bank info today will not result in a payment being withdrawn. You may cancel your policy at any time without any penalty. If the policy is not approved for any reason no charges will be made to your bank account.
Name of Account Holder*
Branch no.*
Institution no.*
Account no.*
Name of Financial Institution*
Billing for (Spouse)
The first monthly premium will not be withdrawn until 1-2 weeks AFTER the policy is approved. A monthly premium will be withdrawn on the effective date of the policy monthly. (Example: Your policy is approved on March 13th, the first premium will be withdrawn around March 28th and the next on April 13th, then May 13th and so on.)

Providing your bank info today will not result in a payment being withdrawn. You may cancel your policy at any time without any penalty. If the policy is not approved for any reason no charges will be made to your bank account.
Name of Account Holder*
Branch no.*
Institution no.*
Account no.*
Name of Financial Institution*
How did you hear about us?
Other
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- We agree to the Client Disclosure terms.

Step 1 of 7

Information About You

Information About Spouse

Birthplace and Citizenship for (You)

Birthplace and Citizenship for (Spouse)

Purpose of Insurance for (You)

Purpose of Insurance for (Spouse)

Existing/Pending Coverages for (You)

Existing/Pending Coverages for (Spouse)

Beneficiary`s for (You)

Beneficiary`s for (Spouse)

Financial Information for (You)

Details

What do you do?

Section Break

Financial Information for (Spouse)

Details

What do you do?

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Medical Questions

Billing for (You)

Billing for (Spouse)