Disability Insurance Fact Finder

Disability Insurance Quote

Please Be Aware: Quotes are available to West Kootenay Businesses and Residents only.

Disability can happen anytime and often very suddenly. RHC Financial offers plans designed to help meet your financial requirements during your disability so you can concentrate on your rehabilitation and returning to your previous life style.

First Name
Last Name
Address
City
Postal Code
Phone (including area code)
E-Mail
Gender  Male Female Do You Smoke?  Yes No
Date of Birth   Are you eligible for EI?  Yes No
Occupation
Are you self-employed?  Yes No
Injury and Sickness?  or Injury only
Gross income (employee) monthly
Net income (self-employed) monthly
Other income in place? Amount?
Benefit Start  15, 31, 60, 90, 121 days
Benefit Duration  2 years, 5 years, 10 years, to age 65
Other Comments
     
Please Be Aware: Quotes are available to West Kootenay Businesses and Residents only.
Head Office: 601A Baker Street, Nelson BC V1L 4J3
Phone: (250) 352-5366   Toll Free: 1 (877) 797-5366   Fax:(250) 352-3324
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