Canadian Independent Disability Insurance Broker & Advisor.

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E-Mail:
daniel.latour@
justincaseinsurance.com

MSN Messenger:(Live Chat)

latourdaniel@msn.com

Skype:
daniel.la.tour

Telephone:
1-514-630-6116

Toll Free Line:
1-888-977-7778

Toll-Free Fax:
1-888-637-2636

Mailing Address:
800 Rene-Levesque Ouest
P.O. Box 1408
Montreal, Quebec
CANADA H3B3L2

Regional Offices:
410-2001
McGill College Avenue
Montreal, Quebec
CANADA H3A1G1

200-1122 4 Street SW
Calgary, Alberta
CANADA T2R1M1

Guaranteed Issue Life Insurance to Protect Your Family

No Medical Exams

No Doctor's reports

No needles

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Save Time & Money. Free, Fast & Easy To Apply. Disability Insurance Request To Quote *Your Personal Data*
Your Name:
Street Address:
City:
Province
Postal Code:
E-Mail (REQUIRED):
E-Mail again for accuracy:
Phone:
Fax (optional):

Marital Status: Single Married	Currently Employed? Yes No

Disability Ins. Currently? (If yes, list carrier, and # of years continuous. If none, type N/C)

UNDERWRITING INFORMATION
Insured Name:
Birthdate:
Insured Height:		Insured Weight:
Insured Occupation:		Sex (M/F):
Exact Work Duties:		Type of Business:
# of Months Worked per year:		# of Hours Worked per week:
% of work at home:	%	% of work Outside home:	%
Monthly Wage (gross income)	$	Do You Smoke?	Yes No

Are Your Covered By: Employment Insurance? Yes No Disability Insurance? Yes No Workers Compensation? Yes No

Please Check the other coverage you may be desiring to have with your disability plan: Income Replacement Overhead Expenses Business Loan/Buy-Sell Critical Illness/Long Term Care
In Dollars, How much of a monthly benefit do you want?		$


When Do You Want Your Disability Policy to Begin?

Choose Waiting Period: (The time that will elapse before your disability payments begin)		30 Days 60 days 90 days 180 days

Choose Benefit Period: (The amount of time you will receive benefits for)		5 Years 10 Years To Age 65

List any current health problems here:
Tell Us What You Want MOST in your Disability Plan, or list any other Remarks here:

Send my quotation via: E-Mail Fax
Regular Mail
Call me by Phone!

Thank you for filling out this form COMPLETELY!
We value your input as PRIVATE information. Every step has been taken to insure your privacy, security, and our intent is to release quote information only to you. We will not give your data to ANY other person or group for sales, marketing, or ANY other purposes. By checking the box below you agree to allow our agency to release this information via the method you have chosen, and to release us from any liability should this information be accidentally viewed by others. Our intention is to maintain your complete privacy.

Yes, I Agree. Please Send Me My
Disability Insurance Quote NOW!

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What we can offer to help you protect your income, savings and quality of life:

I offer a wide range of disability insurance products in order to also preserve the profitability of business owners in case of disability or the disability of a key person.

I offer guaranteed renewable disability insurance products that will allow you to stay within budget and to best meet your needs for enhanced financial security.

I offer a unique concept of guaranteed standard issue to a group of 10 persons or more, without medical underwriting and competitive rebates.

If your Group Benefit Plan does not cover your complete income, our combined limits will allow you to obtain more coverage while combining an Individual Disability Insurance plan with your Group Insurance at work.

If you are a Student graduating from University and on your way to becoming a qualified Professional, our Student initiative program allows certain selected Professionals to obtain, in addition to a 15% discount, an individual disability insurance, without proof of income.

If your self-employed and/or a sales worker, paid on a commission basis, your eligible for a greater amount of disability insurance coverage, thanks to a perk allowance of 20%.

Disability Insurance:
How do I know what to buy?

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