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Are you a Canadian Citizen or Permanent Resident?

Do you have any pending medical tests or ongoing investigations?

Have you ever been treated or diagnosed with AIDS or HIV?

In the past 10 years have you been convicted of a criminal charge For which you have not been granted a pardon for?

Have you used illicit drugs (other than marijuana) in the last 10 years?

Have you ever been diagnosed or treated for: Major Depression, Bi-Polar Disorder, Self-Harm or Schizophrenia?

Do you have any unknown symptoms for which you have not consulted with medical professional?

Do You Have any plans or Intentions to change your Country of residency in the next 12 months?

Have you ever been treated or received counselling for the abuse of drugs or alcohol?

Have you ever had any heart or blood vessel conditions?

have you ever had any brain or nervous system conditions?

Have you ever had any lung conditions?

Have you ever had any liver conditions?

Have you ever had any kidney or bladder conditions?

have you ever had any form of diabetes?

have you ever had any form of cancer?

Have you ever been treated for or had any known indication of:

Have you ever been advised that you should be treat for, or that you had the following:

Have you had more than 2 weeks off work or school in the past 24 months for health reasons?

You do not need to tell us about time off work for pregnancy or for a muscle or bone injury which you have fully recovered from.

Have any of your immediate biological family members been diagnosed with the following before they were 65?

This only includes parents or siblings

How many alcoholic beverages do you consume on a weekly basis?

How Many license suspensions, DUI or moving violations (speeding, cell phone tickets) in the past 5 years?

Do you participate or intend to participate in any dangerous hobbies or sports?

Are you a pilot or crew member for an aviation company?

Within the next 12 months do you have any flights or accommodations booked for travel outside of Canada or The US?

Have you ever been Declined for life insurance in the past?

Please tell us what your job or business is