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Online Application
Actra Fraternal Benefit Society
Group Critical Illness Insurance
Get a Quote
Eligibility &
Details
Health & Lifestyle Questions
Payment Information
Review & Authorization
Complete!
This application will take 15-20 minutes to complete. Please ensure you have a Visa or mastercard for online payment, if your spouse is applying for coverage please have them complete their portion of the application.
Member Coverage
I want
$50,000.00
$25,000.00
$0.00
* of coverage for myself.
Gender:
(Select)
Male
Female
Date of Birth:
In the last 12 months, have you used, in any form whatsoever, tobacco, nicotine or cannabis mixed with tobacco?
Yes
No
Spouse Coverage
I want
$50,000.00
$25,000.00
$0.00
* of coverage for my
Spouse
.
Gender:
(Select)
Male
Female
Date of Birth:
In the last 12 months, have you used, in any form whatsoever, tobacco, nicotine or cannabis mixed with tobacco?
Yes
No
Dependent Child Coverage
I want
$5,000.00
$0.00
* of coverage for my
Dependent Children
.
Quote Summary
Member:
-
Spouse:
-
Dependent Children:
-
-
Monthly Amount
(plus applicable taxes)
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Your personal information is important.
For
you
, because it involves your privacy. For
us
, iA Financial Group and its affiliates, because it allows us to better serve you day by day.
Protecting your personal information is important to us.
By doing business with us, you agree to the collection, use and disclosure of personal information necessary to:
Know who you are.
Identify you and keep your contact information up to date.
Build a relationship with you.
Advise you according to your needs, analyze your requests and identify the products and services that are right for you.
Maintain our relationship with you.
Administer your products and services and process your requests, complaints and claims.
Comply with the laws and manage risk.
For instance, with regard to cybersecurity or the fight against financial crime.
We want to inform you.
Under certain conditions, we may disclose your personal information to your policyholder/sponsor/contract holder when applicable, or any other third party,
if and only if
this disclosure:
is necessary to serve you, or
is made in respect of the choices you have made, or
is in accordance with the law.
We are committed to sharing only necessary information. To learn more, please visit
ia.ca/protection-personal-information
I have read the above and wish to proceed to the online application.
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