Short Form Single Equitable Life Application for Term Insurance -

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Have you recently or will you soon:

Immigrate to Canada?
Buy a home?
Take on a business loan?
Got Married?
Taken out or renewed a mortgage?
Purchased or started a business?
Retired?
Had a baby?
Quit smoking?
Make any other major changes in your life?

If your answer is "Yes" on any of these questions, please email: michael@arbetov.com

Insurance Portal

Saves you time and money to easy buy insurance online, understand the value of health insurance, find out what is the best insurance coverage to buy.
To travel to Canada or from Canada please choose proper web insurance plan for Emergency Medical Insurance and other insurance products for Canadian residents.

Service Area

We are licensed in provinces: Alberta, British Columbia, and Ontario.
To buy visitors to Canada emergency medical insurance or Health and Dental plans you may reside in any Canadian provice such as Alberta, British Columbia, Manitoba, New Brunswick, Newfoundland, Nova Scotia, Northwest Territory, Nunavut, Ontario, Prince Edward Island, Quebec, Saskatchewan, or Yukon Territory and buy coverages online.

We have clients in Abbotsford, Aldergrove, BC Northern, Beaumont, Bowser, Burnaby, Calgary, Chilliwack, Cloverdale, Coquitlam, Delta, Deep Cove, Edmonton, Etobicoke, Fleetwood, Fraser Valley, Greater Vancouver, Kelowna, Ladner, Langley, Maple Ridge, Mission, Nanaimo, New Westminster, North Vancouver, North Bay, North York, Ottawa, Pemberton, Pitt Meadows, Port Coquitlam, Port Moody, Richmond, Sarnia, Squamish, Sunshine Coast, Surrey, Thornhill, Toronto, Vancouver, Vancouver Island, Victoria, White Rock, West Vancouver, Wistler

What Kind of Insurance You Can Buy Here

You can buy on the web any kind of Canadian private insurance. As for internet service it is possible to buy web insurance for traveling abroad as well as buying private medical emergency insurance for visiting Canada. Another medical insurance you can buy online Health and Dental Canadian insurance plan.

Short Form Single Equitable Life Application for Term Insurance

This short form single life term application is for amounts up to and including $500,000. For all other applications our form #350 must be used

Name in Full:*	Proposed Life Insured For Joint Life, Multiple lives, Spousal rider or CPR complete application form #350
Date of Birth (D/M/Y):	Age (nearest):
Sex:	M F
Social Insurance Number:	Place of birth:
Occupation:	Annual Income:
Residence Address:	(Street, City, Province, Postal Code)
Business Phone:
Residence Phone:
Primary Beneficiary:	(All beneficiaries are revocable unless otherwise stated to be irrevocable)
Relationship:
Contingent Beneficiary:	Relationship:
Trustee's Name:	(A trustee is required for minor beneficiaries)
Owner's Name:	(if other than Proposed Life insured)
Relationship:
Owner's social insurance number:
Owner's Address:	(Street, City, Province, Postal Code)
Plan:	10 Year Term 20 Year Term Term to 100
Amount: $:
Smoking Status:	Smoker Non-Smoker
Benefits:	Disability Waiver Basic Convertible Automatic Increase Benefit Additional Accidental Benefit Amount Amount: $: (if checked)
Mode of Payment:	Annual PAP/Withdrawal date (1-28): if checked, include a sample check
Payment made with Application: $:
Have you smoked any cigarettes within the last 12 months?:	Yes No
Have you used any other tobacco products within the last 12 mont:	Yes No
(If YES, specify types and date last used):	Any misrepresentation or misstatement in the answers to these questions shall render any insurance issued in connection with the application voidable by Equitable LifeOfCanada
Name and Address of your usual medical advisor:	(if none, state "None")
Date and Reason last consulted:
Results/Diagnosis and treatment:
Height:	Weight:
Any weight change in the last year? Gain:
Loss:
Reason for weight change:
1.Do you have any Inforce/Pending Life Insurance:	Yes No (if YES, please indicate Company, Year Issued, Sum Insured, Personal/Business)
2.Will this contract replace a Life Insurance Contract:	Yes No (if YES, complete Disclosure Statemenst(s))
3.Have you ever had an application for Life Insurance postponed:	Yes No (Disability, Critical Illness or Group Insurance)
4.Except for vacations,do you intend to travel outside of Canad:	Yes No
5.Has your driver's license been suspended or revoked:	Yes No (or revoked for any reason within the last 3 years, if YES, provide driver's license number, reason(s) and date(s))
6. In the last 2 years have you or do you intend to:	Yes No a)make any flights other than as a fare-paying passenger
b) Engage in any hazardous sport or hobby:	Yes No (e.g. scuba diving, hang gliding, skydiving, motor racing, mountain climbing)
7a.Do you drink alcoholic beverages:	Yes No (if YES, specify type and weekly consumption)
b.Have you ever received advice pertaining to use of alcohol:	Yes No (or treatment)
c.Have you ever used marijuana,or any illegal or addictive drugs:	Yes No (or received treatment for drug addiction)
8.Mental or nervous disorder:	Yes No (have you been diagnosed, had any known indication of, or been treated for ane mental or nervous disorder (e.g. depression, anxiety), epilepsy, or fainting spells)
9.Heart, stroke or circulatory trouble:	Yes No (have you ever been treated for, or had any indication of heart, stroke or circulatory trouble, chest pains, high blood pressure, diabetes, kidney or liver disease, blood disorder, cancer or tumors of any kind)
10a.AIDS, ARC, any other immunological disorder:	Yes No (have been diagnosed, had treatment for, or have had any indication of possible exposure to)
b.Positive test result indicating exposure to AIDS:	Yes No
11.Respiratory disorder, bladder disorder, hepatitis...:	Yes No (Have you ever been treated for respiratory disorder, bladder disorder, hepatitis or gastro-intestinal disorder, muscle or bone disorder)
12.Do you regularly take any medication:	Yes No (f YES, specify type and dosage)
13.Have you consulted any physician within the last 5 years:	Yes No (for reason, which details are not given above)
14.Are you aware of any symptoms or complaints:	Yes No (regarding your health, for which you have not yet consulted a physician)
15.Have you been advised to have surgery, treatment or testing:	Yes No (which has not been completed)
16.Is there Family History of ...:	Yes No (Huntington's Chorea, Diabetes, Cancer, High Blood Pressure, Heart or Kidney Disease)
Details of all "YES" answers for Questions 1-16:	(indicate question number, dates, diagnosis, doctors/hospitals, treatment etc.)

Required fields are marked with: *

Tax Reduction Insurance

Apply For Canadian Health Dental Plan Insurance (On-Line)
(8 packages)

It helps you to reduce taxes, manage a budget, decrease the financial risk from unexpected events with your health or teeth problems.

Apply For Canadian Health Dental Individual/Family Benefits Plan Insurance (On-Line)
(Create your own plan with add-ons, Core-Plan, Flex-Care Plan, Follow Me Plan - conversion when your employment benefits end)

Would you like to review or discuss:

Life Insurance ?
Retirement Planning?
Income Replacement for Disability?

Check The Prices and Apply Online For Health And Dental Plan For Canadian Small Business Owners Easy Insurance

Save Money for Your Kids Education?
Canadian Personal Tax Reduction?
Travel To Canada Insurance On-Line?

If your answer is "Yes" on any of these questions, please email: michael@arbetov.com
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Free Website Submission Here to submit a link to your website if it is related to our business or if you are Arbetov Insurance and Wealth Management's client Insurance Web Directory Here.

Insurance Providers

We can offer the service from the majority of Canadian life insurance companies.
Among them are top-rated companies:
TIC - Travel Insurance Coordinators
Pacific Blue Cross Canada
Travel Underwriters
AIG Life Canada
Blue Cross Canada Insurance
Canada Life - the oldest Canadian insurance company,
Great West Life Canada
Empire Financial Canada
Equitable Life - one of the biggest Canadian mutual insurance companies
Federated Insurance
Green Shield Canada
IAP - Industrial Alliance Pacific of Canada
Manulife Canada - Manufacture Life, one of the biggest in Canada insurance company, is a leading provider of life, health, disability and travel insurance.
RBC Insurance
Standard Life Canada
Transamerica Life

We are also able to submit a contract with almost any of other life insurance, critical illness insurance, disability insurance, travel insurance, visitor insurance, dental and medical insurance, long term care insurance companies if they would service the financial needs of existing and prospective clients better then current ones.
International Insurance

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