If you would like a quotation for Familysure
coverage please complete the following form
or call 1-800-529-4333
What is the support payor's name?
What is  support payor's gender?
What is support payor's date of birth ?
Has support payor smoked in the last 12 months?
What province does support payor live in?
ENTER support payor's annual income...
What is the youngest child’s name?
What is child 1's date of birth?
What is the next youngest child’s name?
What is child 2's date of birth?
What is the next youngest child’s name?
What is child 3's date of birth?
What is the next youngest child’s name?
What is child 4's date of birth?
ENTER the monthly CHILD support amount here
Benefits continue until each child reaches the target age of …
Do you want the Child support Insurance Benefits indexed to inflation?
If you pay spousal support ENTER the monthly amount...
What is the spouse's name?
What is the spouse's date of birth?
ENTER the spouse's approximate annual income...
Has the spouse smoked in the last 12 months?
Do you want the spousal support insurance benefits indexed to inflation?
ENTER the age of the spouse when support ends?
What email address do you want a quotation sent to?




If this quote request is being completed by a lawyer,
please enter lawyer's name here.
thefamilylawinsurancecentre