CanadaLifeQuote.com - Guaranteed Life Insurance Quote

Custom Guaranteed Issue Quote

Guaranteed Issue Life Insurance was designed to answer the needs of people who want insurance coverage without the bother of medical exams, or who simply don’t want to answer the many and varied questions linked to their state of health. No medical exam. No blood test. No x-rays. No ECG's. No financial verification. Fill out the form below to receive your customized Guaranteed Issue Life Insurance Quote.

*Full Name

*Email

*Telephone # (include area code)

*Best time to contact you:

*Have you been previousy declined for life insurance? No Yes

*Date of Birth (MM/DD/YYYY)

*Sex Female Male

*Coverage Amount

I am currently capable of carrying out by myself any basic activities of daily living such as:

getting up, walking, washing, dressing, eating and I'm not suffering from incontinence.

I am not currently admitted to a hospital, clinic or extended care facility OR a resident of a

health establishment such as a nursing home OR a residential care centre OR a resident of

a home for individuals with reduced physical or mental autonomy.

I am not currently being tested for and have not been diagnosed with, informed of or treated

for any type of cancer during the past 3 years; nor have I been test positive for AIDS or the HIV virus.

In the last two years I have not used, drugs such as opium, heroin, morphine, codeine, Demerol,

barbiturates, amphetamines, cocaine, hallucinogens, anabolic steroids, other than as prescribed

by a doctor, or methadone as prescribed or not by a doctor.

*Required