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Step
1
of 4
Welcome!
What type of insurance are you looking for ?
*
Cover my final expenses (i.e. funeral, medical)
Create a safety net for my family
Debt Protection (Mortgage, Loan, Credit cards)
Replace/ additional coverage to an existing policy
Build Wealth (Get approx 6% tax-free investment annual growth)
No - Medical Insurance
Disability - Income Protection
Serious Illness - Income Protection
Medical Emergency - (Travel Insurance)
Medical Emergency - (Super Visa Insurance)
Health Coverage (Prescribed Drugs, Dental, Eye care, Therapy etc)
Unsure
Next
Coverage Amount
*
$0 - $50,000
$50,000 - $100,000
$100,000 - $200,000
$200,000 - $300,000
$300,000 - $400,000
$400,000 - $500,000
$500,000 - $600,000
$600,000 - $700,000
$700,000 - $800,000
$800,000 - $900,000
$900,000 - $1,000,000
$1,000,000 - $5,000,000
$5,000,000 - $25,000,000
How much can you afford per month?
*
$25
$25 - $50
$50 - $75
$75- $100
$100 - $150
$150 - $250
$250 - $500
Do you Smoke?
*
Yes
No
You should select ‘Yes’ if you have had any nicotine products in the last 12 months Including Cigarettes, E-Cigarettes, Pipes, Chewing Tobacco, Vaporizers, Nicotine Gums, Nicotine Patches, 13 or more Cigars
Note
: Cannabis Products are ‘Not’ considered to be Nicotine or tobacco products.
Next
Name
*
First
Last
Layout
Date of Birth
*
Province
*
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
North West Territories
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon Territories
Phone Number
*
Gender at birth
*
Male
Female
Postal Code
*
Best time to call
*
Weekday (Morning)
Weekday (Afternoon)
Weekday (Evening)
Weekend (Morning)
Weekend (Afternoon)
Email
*
Next
How did you first hear about us?
Search Engine
Social Media
Online Ad
Friend/Family
Express Consent
*
I agree to allow
cibithomas.com
to send me any commercial electronic messages, including in respect of member benefits, products, news, updates, and promotions. Commercial electronic message formats may include, but are not limited to, SMS*, email, and digital messaging. I may withdraw my consent at any time through the unsubscribe link in any message or by e-mail to
info@cibithomas.com
. See our Privacy Policy for more details on how we protect your personal information. Message and data rates may apply*
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