Get A Quote

Although we expect to offer coverage to the majority of applicants declined by other insurers, there are certain impairments or combinations of impairments that will not be considered. Please refer to the Uninsurable Impairments before proceeding to collect an application.
To obtain a quote, please provide us with as much of the information requested below as you can. The more detailed information you provide, the more accurate our quote will be.

Note that only the fields marked with an asterisk (*) are mandatory.

If you require assistance, please call us at:
Direct: 416-322-7268, ext. 1 or
Toll Free 1-888-995-9199, ext. 1

Information About Your Client/Potential Applicant

Requires no use of tobacco or related products for at least 12 months.

Heightfeet/inches or

Weightpounds or

Approximate Date of Diagnosis  Month

Approximate Date of Diagnosis  Month

Approximate Date of Decline  Month

Acceptional Life® is a trade-mark of Co-operators Life Insurance Company and is used under licence.