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* Sex:
* Smoker:
Select Your Coverage Amount
NOTE:

Non-Smoker rates are available to people who have not used any form of tobacco, tobacco cessation products or marijuana in the past 12 months and who meet Manulife's health standards.

Provincial taxes may apply.

    An applicant may apply and be approved for this simplified issue offer a maximum of one time. Any additional coverage issued pursuant to this simplified issue offer shall be voidable at the option of the insurer.
  • Within the last 24 months have you been disabled or missed more than 10 consecutive days from work or school because of injury or illness?
  • Yes No
  • Have you ever been diagnosed with or have pending investigations for:
    • Coronary Artery Disease
    • Cancer
    • Diabetes
    • HIV
    • Heart Attack
    • Stroke
    • Transient Ischemic Attack (TIA)
  • Yes No
  • Have you ever had an application for life insurance declined, rated, postponed, cancelled/rescinded, or modified in any way?
  • Yes No
    Since you have answered “Yes”, we regret that you are not eligible for the CAA Simplified Term 5 application. Please proceed to the full CAA Term 5 application.

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