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Critical Illness
37 Covered Critical Illnesses
No Medical Life Insurance
Accident Insurance
Accident Benefit
Accidental Death Insurance
Children Insurance
Children 360 Insurance
Children Critical Illness Coverage
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#802-7030 Woodbine Ave, Markham, ON, L3R 6G2
1-866-496-3299
info@cicentre.ca
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General Inquiry
Children360 Insurance
Accident Insurance
Critical Illness Insurance
No Medical Life Insurance
General Inquiry
First Name
Last Name
Type of coverage interested in:
Life Insurance
Accident Insurance
Critical Illness
Not Sure
I agree to CIC’s
Privacy Statement
and
CASL
(Canada’s Anti-Spam Legislation).
Submit Application
Application – Children360 Insurance
Personal Information
First Name
Last Name
Relationship to Child
– Select –
Parent
Guardian
Other
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Next
Your Children’s Information
How many children do you have?
– Select –
1
2
3
4
5
5+
Please list the ages of your children.
Does the child have any pre-existing medical conditions?
Yes
No
If yes, please specify:
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Next
Insurance Inquiry Details
Type of coverage interested in:
Life Insurance
Critical Illness
Both
Do you have any current insurance policies for the child?
Yes
No
If yes, please specify:
Previous
Next
Location of Coverage
What’s Your Address?
Select Country
Canada
I agree to CIC’s
Privacy Statement
and
CASL
(Canada’s Anti-Spam Legislation).
Submit Application
Previous
Application – Critical Illnesses
Personal Information
First Name
Last Name
Previous
Next
Insurance Inquiry Details
Type of coverage interested in:
Life Insurance
Critical Illness
Both
Do you have any current insurance policies for the child?
Yes
No
If yes, please specify:
Previous
Next
Location of Coverage
What’s Your Address?
Select Country
Canada
I agree to CIC’s
Privacy Statement
and
CASL
(Canada’s Anti-Spam Legislation).
Submit Application
Previous
Application – Critical Illnesses
Personal Information
First Name
Last Name
Previous
Next
Insurance Inquiry Details
Type of coverage interested in:
Life Insurance
Critical Illness
Both
Do you have any current insurance policies for the child?
Yes
No
If yes, please specify:
Previous
Next
Location of Coverage
What’s Your Address?
Select Country
Canada
I agree to CIC’s
Privacy Statement
and
CASL
(Canada’s Anti-Spam Legislation).
Submit Application
Previous
Application – Critical Illnesses
Personal Information
First Name
Last Name
Previous
Next
Insurance Inquiry Details
Type of coverage interested in:
Life Insurance
Critical Illness
Both
Do you have any current insurance policies for the child?
Yes
No
If yes, please specify:
Previous
Next
Location of Coverage
What’s Your Address?
Select Country
Canada
I agree to CIC’s
Privacy Statement
and
CASL
(Canada’s Anti-Spam Legislation).
Submit Application
Previous
