or contact us online!

• INSURANCE
• CFMS
• PUBLIC SPEAKING
• FINANCIAL PLANNING
• ABOUT & CONTACT
• REQUEST A QUOTE

• Main Page
• About & Contact
• Request a Quote

Online Quote Request

Please take a minute and fill out the form below. Living Benefits Atlantic will then contact you and provide you with an individualized quote based upon the coverage you require. This service is offered free of charge without any obligation.

Corry is licensed and can provide quotes to residents of Nova Scotia, New Brunswick, Newfoundland and Labrador, and Ontario. Quote requests from the remaining provinces can be passed to a licensed advisor in the province of residence.

Personal Information

Enter your personal information.

Please provide as much detail about any health conditions that you might have.

* denotes a required field.

Personal Information

* Name:
* Date of Birth:	Month-----JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember Day---12345678910111213141516171819202122232425262728293031 Year----2010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920191919181917191619151914191319121911
* Gender:	Male Female
* Smoking Status in the past 12 months:	Non-Smoking Smoking
List any specific health issues:

Occupational Information

Fill out the fields that apply to you.

If you are a student, please list your occupation as "Student."

* denotes a required field.

Occupational Information

* Occupation:
Employer (Company or Hospital):
* Total income in the last 12 months:
Are you Incorporated?	Yes No
Are you a Medical Student?	Yes No

Contact Information

Enter as much of your contact information are you care, and please advise us how you would like to be contacted.

* denotes a required field.

Contact Information

* Daytime Phone:
Evening Phone:
* Email Address:
Mailing Address:
Preferred Method of Contact:	Phone (Business Hours) Phone (Evening) Email Canada Post

Requested Information

Click the checkboxes for more information on our services.

Request Information on the Following Products:

Disability Insurance		Life Insurance as an Investment
Retirement Protector Insurance		Term Life Insurance
Critial Illness Insurance		RRSP
Business Overhead Insurance		CFMS Disability Quote

Other Information

Add any other information you would like to share:

Please type the following letters into the box below. This helps us to filter unwanted spam messages.

© 2007-2008 Living Benefits Atlantic Ltd.

GIVE US A CALL
1-902-444-7000