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 What's New
2009-07-10
Mike Taylor interviewed by Mon
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2009-06-04
Mike Taylor interviewed by IE:TV
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2008-11-20
SecureLife maximum increased to $500,000!
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2008-04-03
Hunter McCorquodale launches new website
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2008-04-03
Hunter McCorquodale launches SecureDI - a new plan for your disability insurance medical declines!
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Get A Quote: SecureDI

To obtain a quote:

  1. First check the SecureDI Pre-Screening Guide to verify that your client's medical condition is not listed as one that we are unable to consider for coverage.
  2. Complete and submit the following form. We will respond within two business days.


Quote Request Form (* denotes mandatory field)

Client name:
*Date of Birth (day/month/year) or Age:
*Gender: Male Female
*Smoking status: Non-smoker (no tobacco or substitutes for the last 12 months)
Smoker (others)
*Occupation:
*% manual duties:
*Monthly Benefit Amount: $
quote maximum monthly benefit based on annual income of
        $
*What is the medical condition(s):
*When was it diagnosed:
*What treatment or medication has been given for the condition:
*What current symptoms or complications is the client experiencing, if any?
*Has the condition worsened in the last 12 months? Yes
No
*Has the client missed any work in the last 12 months due to the condition? Yes, how much?
No
Is there any other information that would be helpful to our underwriter in evaluating this inquiry?
*Your Name:
*Your Email Address:
*Your Telephone Number:

Please provide the following additional information, to be added to our mailing list:

Your Company Name:
Your Address:
Do you receive mail by: ICS
Regular Mail

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