Getting Started
Is Easy

Tell us a little about yourself, get a quote for the plan that suits your needs best, and apply online today. No agent will call unless you need assistance. It will take you just a couple of minutes from start to finish and it could save your executor months of work, stress and aggravation.

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My first name is

My middle initial is

My last name is

I am a

Born on (dd/mm/yyyy)

Aged

I live in

I estimate my estate will be worth about

So far so good. Please answer the following two questions so we know which plans we can offer you.

1. Are you currently confined to a hospital or nursing home, or have you ever been diagnosed as having a terminal illness, Alzheimer's Disease, tested HIV positive or been advised that you have AIDS-related Conditions?
NoYes

2. During the past five (5) years, have you ever been treated for, or been diagnosed as having:

Disease or disorder of the heart, circulatory or vascular systems, stroke or any cancer?
Disease or disorder of the lungs, liver or kidney; alcoholism or drug abuse?
Brain disorder or tumour, seizure, paralysis, psychosis, lupus or multiple sclerosis?
Blood disease or disorder, or both high blood pressure and diabetes together?

NoYes

Thank you!

You qualify for Guaranteed pricing and all payment options, though benefits are limited to return of premium plus 6% interest for the first two years. For more information, please see the Terms & Conditions here.

Congratulations! You qualify for Preferred pricing and multiple payment options.

Which plan suits you best?

The premium for your selected coverage is $ per month. It's a convenient . This provides guaranteed issue of a fully paid-up executor liability insurance policy for your estate with estimated value of $, plus guidance, support and direction for your executor, providing protection, peace of mind and family harmony.

This is funded with $ of the proceeds of this policy. You have $ of optional coverage available for executor compensation and/or final expenses.

You qualify for a single pay policy, which ensures your executor will have guaranteed executor insurance coverage, guidance and direction.

Show Me Enhanced Coverage Options

Optional Coverage 1
Executor Compensation

Executor compensation can cause problems between the executor and beneficiaries. Eliminate the discussion and the need for approval by beneficiaries and/or a Court by arranging to have funds set outside the estate to pay your executor for the multitude of tasks they will perform, on a non-taxable basis to your executor.

Amount to pay your executor

Monthly amount for your executor: $

Current total: $

Optional Coverage 2
Final Expenses

Arrange to have immediate funds made available to your executor to cover some of the expenses that families face, without asking the executor to pay for the out of their own pocket. In many cases, bills (including the funeral) are due before the estate administration is complete.

Amount for final expenses

Monthly amount for final expenses: $

Current total: $

Beneficiary Details (if different than executor)The Beneficiary is the recipient of the “Other Final Expenses” amount if so indicated. To ensure that funds are available immediately, name the executor. If the Beneficiary section is left blank the Certified Owner (if living) or the Certificate Owner’s estate will be the Beneficiary by default, and funds will not be immediately available to pay final costs.

Name

Relationship

Phone

Email

Address

City

Province

Postal code (no spaces)

Application

Just fill out a few more details to submit your application.

Email

Phone number

SIN

Occupation

Mailing Address

Address

City

Province

Postal code (no spaces)

Physical Address (if different)

Address

City

Postal code (no spaces)

Executor DetailsThe Executors/Estate Administrators are person(s) named in a will by the Applicant to administer his/her estate and is/are the individual(s) who will be covered by the Estate Risk Protection Plan.

Number of Executors

Primary Executor Name

Relationship

Phone

Email

Address

City

Province

Postal code (no spaces)

Payment

Select payment type (please note that credit card payment is not available for single pay)

Payment term

PAC Date

PAC Account

Credit Card Type

Credit Card Number

Exp (mmyy, please do not use a / between the month and year)

Security code

In name of

Certificate Owner InfoPremiums may be paid by cheque, PAC or Credit Card (Time Pay only). Check the frequency (M Q) and the payment period (Single, 3, 5, 10, 15, or 20 years).
If PAC is selected, indicate the day of the month subsequent/renewal premiums are to be drafted, indicate if the bank account is chequing or savings, and attach a void cheque to the Enrollment Form. This is not when the first premium will be drafted immediately, i.e. when the Enrollment Form is processed.
If payment is by Credit Card, check MasterCard or Visa, fill in the Credit Card number, expiry date and security code. Also indicate whether the credit card belongs to the Applicant, Owner or Other Payor (if “Other Payor”, complete Form 0058-12). Credit Card payment is not available with Single Pay options.

First name

Middle initial

Last name

Date of birth

Age

Gender

SIN

Occupation

Relationship to applicant

Phone

Email

Address

City

Province

Postal code (no spaces)

Does the certificate owner have power of attorney?

Signature (type your name again):

Signed at: (please give city and province)

An agent assisted me with my application:

NoYes

Agent code

Signature (agent types name):

Your current total is: $

I understand that the coverage being applied for does not immediately purchase services or estate protection. It is used to purchase them at a later time. I hereby irrevocably assign as its interest may lie the Estate Services death benefit of the certificate applied for and to be issued to the Estate Risk Protection Plan Inc. to provide estate services and an estate protection policy for my executor/estate.
I agree to and understand the following: a) no coverage shall exist until the certificate is issued while the Applicant is living and the initial premium is paid; b) this certificate does not replace any insurance policy or annuity; c) I am enrolling as a member of the Association for Personal Resource Planning of Canada (APRP) to which Assurant group annuity plans are provided; d) my death benefit may be partially or entirely reduced in the event I misrepresented any material informa- tion on this enrollment for insurance; e) the personal information in this form will be kept secure and confidential and will not be disclosed except as permitted by law or at my signed request.
By completing this form, I acknowledge that Estate Risk Protection Plan Inc. will collect, use and disclose my personal information to third parties, including my lawyer, as necessary for underwriting purposes, to fulfill risk mitigation services, and to fulfill the contract in accordance with applicable legislation. Estate Risk Protection Plan Inc. will: a) not collect, use or disclose my personal information for any purpose other than those that they identify to me; b) keep my personal information only for as long as needed to fulfill the stated purpose or as required by law; c) maintain my personal information in as accurate, complete and up-to-date a form as possible; d) safeguard my personal information to the best of their ability; and e) respond to any request I may make to access or correct the personal information they hold about me.
In order to provide the best service and information for applicants, co-applicants, and executors, Estate Risk Protection Plan Inc. must request my consent to allow communication and to send important information and announcements. My signature below forms consent required to comply with the Anti-Scam Legislation CCASLl.

I have read and agree to the above

Signature (type your name again):

Signed at: (please give city and province)

Date signed (DD/MM/YYYY):

I still have questions

What would you like to know?

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