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Personal Information

First Name * Please enter your first name

Last Name * Please enter your last name

Date of Birth *

Please select your complete date of birth

Gender *

Male Female

Please select your gender

Email Address * Please enter a valid email address

Cell Phone *

Please enter a valid 10-digit Canadian phone number

Preferred Language *

English French

Please select a preferred language

Legal Status in Canada * Please select your legal status

Country of Birth * Please enter your country of birth

In Canada Since (if not born here) I was born in Canada — skip this field

Please select when you arrived in Canada

Home Address

Street Address * Please enter your street address

City * Please enter your city

Province * Please select your province

Postal Code * Please enter a valid postal code

Beneficiary Information

The person who receives the AD&D benefit in the event of accidental death.

First Name * Please enter the beneficiary's first name

Last Name * Please enter the beneficiary's last name

Relationship * Please select the relationship

Distribution % * Enter 100 if sole beneficiary

Designation *

Revocable Irrevocable

Declarations

We, the primary insured and the policyholder, declare and understand the following:

1 — Accuracy of Information I declare that all answers and explanations provided in this application are true and complete, and they constitute the basis for the insurance coverage.

2 — Misrepresentation I understand that if any misrepresentation or material omission is made, the insurer shall not be held to any obligation under any insurance issued upon acceptance of this application. Misrepresentation may result in cancellation.

3 — Policy Terms I understand that all benefits payable are subject to the conditions, definitions, limitations, and exclusions set out in the contract, and I confirm my advisor has had the opportunity to explain these details to me.

4 — Effective Date I understand and agree that coverage will take effect on the submission date, provided the application is accepted without modification and the premium has been paid and honoured.

Insured Declaration — Required 5 — Current Health Status I, the insured, declare that I am not currently disabled and have no permanent physical or mental disability.

⚠ Please confirm all five declarations above before submitting your application.

Your privacy is protected. Information is transmitted via SSL encryption and is never stored on this website. Data is sent directly to EGE Insurance Canada's CRM system on Canadian servers, compliant with the Personal Information Protection and Electronic Documents Act (PIPEDA). We do not sell, share, or disclose your information outside the insurance application process with iA Financial Group.

Pre-Qualification Received

A licensed EGE advisor will contact you to confirm eligibility, collect your void cheque and banking details, then complete the official iA Financial Group application with you over the phone.

Note: If you do not hear from an advisor within 2 business days, please call 416-477-1516 to confirm receipt.

What Happens Next

Advisor ContactAn EGE advisor reaches out within one business day to confirm interest and eligibility.

Coverage ReviewReview of each selected coverage — benefits, exclusions, and total premium.

Banking SetupVoid cheque collection for pre-authorized monthly payments with iA Financial Group.

Official ApplicationComplete iA Financial Group application over the phone with e-signature.

Policy IssuedCoverage activates once iA accepts the application and first premium is received.

Call 416-477-1516 Email Support Back to ACCI 7 Plus

Pre-Qualification Application

Pre-Qualification Received

What Happens Next