Life & Travel Policies Please enable JavaScript in your browser to complete this form.Line of Business *Please SelectLIFETRAVELPolicy Type *Please Choose from DropdownTERMPERMANENTWHOLE LIFEUNIVERSAL LIFECRITICAL ILLNESSDISABILITYFirst and Last Name of Client *Effective Date *Carrier written withChoice 1Allianz Global AssistanceBeneva Insurance & Financial ServicesCanada LifeCanada Protection PlanDesjardinsEmpire LifeGreen Shield CanadaIndustrial AllianceManulife FinancialOntario Blue CrossRBCRIMISun Life CanadaTruStone HealthDate the Policy was signed *Date sent to IDCPolicy Status *Please Choose from DropdownNew BusinessRemarketRenewalPREMIUM AMOUNT *RIDER AMOUNT ($)Checklist for Life PoliciesClient File Documentation ChecklistFinancial Needs AnalysisLog NotesIllustration(s) (Signed)Policy Delivery Receipt(s) (Signed)Application Form(s) (Signed)Medical Insurance Bureau Notice Given to ClientPre-Authorized Debit Agreement, including void cheque (Signed)Temporary Insurance Agreement (if applicable)LIRD (if applicable) (Signed)Investor Profile(s) for UNIVERSAL LIFE & SEGRETATED FUNDS: KYC, Risk Tolerance, and Sales Charge Disclosure, as well as Leverage Questionnaire and Suitability (if applicable) (Signed)Name of Producer *Client's Email *Client's Phone Number *Carrier *Please SelectIngle Assurance LtdAllianz Gobal InsuranceTravel Insurance ChecklistPolicy Receipt – Summary PagesPolicy ItemsMedical Statement (if applicable)In the Event of a ClaimPayment ConfirmationAdditional Information For Travel BenefitsNote from the BrokersEmail *Submit