We are pleased to help you understand your life insurance requirements better. This web-form is encrypted for your protection, and as well, we are 100% committed to your privacy. Your personal information will never be shared, sold or transmitted by Allan Financial to any third party without your explicit prior consent

Please enter rough estimates to answer the following few questions so we can understand your coverage requirements.

Fields marked * are required. Please enter N/A if information unavailable or not applicable.

Contact Information
Please provide us with your contact information so that an Allan Financial representative can contact you.
Salutation *		-- SELECT SALUTATION -- Mr. Mrs. Ms. Dr.
Full Name *
Telephone number (with area code) *
Email Address *
Assets: please estimate the current value of each
Home Equity: * (i.e. the amount of value that you own in your home)
Savings: * (i.e. cash, GIC's and other guaranteed investments)
Investments: * (i.e. RSP's, Mutual Funds, etc.)
Other: * any other substantial investments you may hold (please specify)
Liabilities: please estimate all outstanding monies owed
Mortgage Principle Outstanding *
Credit * (lines of credit, credit cards)
Other Liabilities *
Monthly Expenses: please enter all monthly expenses
Mortgage Payment *
Monthly Bills *
Other Monthly Expense 1 (amount & detail) *
Other Monthly Expense 2 (amount & detail) *
Other Monthly Expense 3 (amount & detail) *
Other Monthly Expense 4 (amount & detail) *
Other Monthly Expense 5 (amount & detail) *
Other Monthly Expense 6 (amount & detail) *
Marital Status *
Single
Common Law
Married
Divorced
Age
Your Age *
Spouse's Age *
Please list dependents' ages
Dependent One *
Dependent Two *
Dependent Three *
Dependent Four *
Dependent Five *
Current Policy Evaluation
Please provide the following information regarding your current policy. If you don't have this information or would prefer not to enter it here, simply skip this section and we'll obtain it when we contact you.
The name of your current provider
Whether your policy is term insurance or otherwise
The amount of the payout
Your monthly or annual premium
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