fbpx Skip to content
logoo
Need help? Give us a call
Book a Call
Need help? Give us a call
logoo
Book a Call

Extreme Sports Insurance Application

Extreme Insurance Application (CPP and iA)

Step 1 of 10

10%
  • Hidden
  • Hidden
  • Hidden
  • Hidden
  • Hidden
  • Hidden
  • Hidden
  • Hidden
  • Personal Information and Prequalification for (You)

  • MM slash DD slash YYYY
  • Medical Questions Part 1 for (You)

  • Medical Questions Part 2 for (You)

  • Medical Questions Part 3 for (You)

  • Medical Questions Part 4 for (You)

  • Medical Questions Part 5 for (You)

  • Within the last three (3) years:

  • Medical Questions Part 6 for (You)

  • Within the next two (2) years:

  • General Declarations for (You)

  • iA Financial group, its affiliates and their agents can access information about me in order to know me better, better meet my needs and offer the best possible service and client experience. (If you do not wish to allow this access, please write to livingbenefits@ia.ca.)
  • Beneficiary Information 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.

  • Hidden
  • Hidden
  • Hidden
  • Hidden
  • Hidden
  • Hidden
  • Hidden
  • 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.

  • Hidden
  • Hidden
  • Hidden
  • Hidden
  • Hidden
  • 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.

  • Billing (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.
Final-Logo Transparent
  • Terms of Use
  • Privacy Policy
Facebook-f Instagram Youtube Linkedin-in

Affinity Life Inc., is an insurance brokerage licensed to sell life insurance products in Alberta and British Columbia. We are currently not available in other provinces. Policy obligations are the sole responsibility of the issuing insurance company. Coverage is subject to underwriting by the selected insurance company. Please see policy documents for full terms, conditions, and exclusions. The logos and trademarks used here are owned by the respective entities. Refer to our Privacy Policy and Terms of Use for additional information.