{"id":20086,"date":"2025-05-13T14:57:38","date_gmt":"2025-05-13T18:57:38","guid":{"rendered":"https:\/\/www.assur360.ca\/quick-quote-life-insurance\/"},"modified":"2026-09-02T12:41:11","modified_gmt":"2026-09-02T16:41:11","slug":"quick-quote-life-insurance","status":"publish","type":"page","link":"https:\/\/www.assur360.ca\/en\/quick-quote-life-insurance\/","title":{"rendered":"Quick quote life insurance in Quebec"},"content":{"rendered":"\n<div style=\"height:93px\" aria-hidden=\"true\" class=\"wp-block-spacer\"><\/div>\n\n<div class='fluentform ff-default fluentform_wrapper_49 ffs_custom_wrap'><form data-form_id=\"49\" id=\"fluentform_49\" class=\"frm-fluent-form fluent_form_49 ff-el-form-top ff_form_instance_49_1 ff-form-loading ff-form-has-steps ffs_custom\" data-form_instance=\"ff_form_instance_49_1\" method=\"POST\" ><fieldset  style=\"border: none!important;margin: 0!important;padding: 0!important;background-color: transparent!important;box-shadow: none!important;outline: none!important; min-inline-size: 100%;\">\n                    <legend class=\"ff_screen_reader_title\" style=\"display: block; margin: 0!important;padding: 0!important;height: 0!important;text-indent: -999999px;width: 0!important;overflow:hidden;\">Soumission assurance vie (#49) @Enzo<\/legend><input type='hidden' name='__fluent_form_embded_post_id' value='20086' \/><input type=\"hidden\" id=\"_fluentform_49_fluentformnonce\" name=\"_fluentform_49_fluentformnonce\" value=\"277fcdecbe\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/en\/wp-json\/wp\/v2\/pages\/20086\" \/><div class='ff-step-container' data-name=\"step_start-49_5\" data-disable_auto_focus=\"no\" data-enable_auto_slider=\"no\" data-enable_step_data_persistency=\"no\" data-enable_step_page_resume=\"no\" data-animation_type=\"slide\" data-progress_layout=\"top\" data-progress_indicator=\"steps\" ><div class='ff-step-header'><ul class='ff-step-titles ff-step-titles-navs ff-step-titles--clickable' role='group' aria-label='Form steps' aria-live='polite'><li class=\"ff_active\"><span class=\"ff-step-title-text\">Montant<\/span><\/li><li class=\"\"><span class=\"ff-step-title-text\">Identit\u00e9<\/span><\/li><li class=\"\"><span class=\"ff-step-title-text\">Coordonn\u00e9es<\/span><\/li><li class=\"\"><span class=\"ff-step-title-text\">Profil<\/span><\/li><li class=\"\"><span class=\"ff-step-title-text\">Consentement<\/span><\/li><\/ul><\/div><span class='ff_step_start'><\/span><div class='ff-step-body'><div class=\"fluentform-step active\" data-name=\"step_start-49_5\" data-disable_auto_focus=\"no\" data-enable_auto_slider=\"no\" data-enable_step_data_persistency=\"no\" data-enable_step_page_resume=\"no\" data-animation_type=\"slide\" data-progress_layout=\"top\" data-progress_indicator=\"steps\" ><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_49_dropdown' id='label_ff_49_dropdown'>How much life insurance is required?<\/label><\/div><div class='ff-el-input--content'><select name=\"dropdown\" id=\"ff_49_dropdown\" class=\"ff-el-form-control\" data-name=\"dropdown\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=\"false\" aria-labelledby=\"label_ff_49_dropdown\"><option value=\"\">- Select -<\/option><option value=\"50 000$\"  >$50,000<\/option><option value=\"100 000 $\"  >$100,000<\/option><option value=\"200 000 $\"  >$200,000<\/option><option value=\"300 000 $\"  >$300,000<\/option><option value=\"400 000 $\"  >$400,000<\/option><option value=\"500 000 $\"  >$500,000<\/option><option value=\"600 000 $\"  >$600,000<\/option><option value=\"700 000 $\"  >$700,000<\/option><option value=\"800 000 $\"  >$800,000<\/option><option value=\"900 000 $\"  >$900,000<\/option><option value=\"1 000 000 $\"  >$1,000,000<\/option><option value=\"2 000 000 $\"  >$2,000,000<\/option><option value=\"3 000 000 $\"  >$3,000,000<\/option><option value=\"4 000 000 $\"  >$4,000,000<\/option><option value=\"5 000 000 $\"  >$5,000,000<\/option><option value=\"10 000 000$\"  >$10,000,000<\/option><option value=\"Autres\"  >Other<\/option><\/select><\/div><\/div><div class='step-nav ff_step_nav_last'><button style='float: left;'  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary' aria-label='Previous'>Previous<\/button><button style='float: right;'  type='button' data-action='next' class='ff-float-right ff-btn ff-btn-next ff-btn-secondary' aria-label='Next'>Next<\/button><\/div><\/div><div style='display: none;' class=\" fluentform-step\" data-name=\"form_step-49_1\" ><div data-type=\"name-element\" data-name=\"names\" class=\" ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group  ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_49_names_first_name_' id='label_ff_49_names_first_name_'>First Name<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[first_name]\" id=\"ff_49_names_first_name_\" class=\"ff-el-form-control\" placeholder=\"First Name\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell '><div class='ff-el-group  ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_49_names_last_name_' id='label_ff_49_names_last_name_'>Surname<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[last_name]\" id=\"ff_49_names_last_name_\" class=\"ff-el-form-control\" placeholder=\"Surname\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label  >Background (we have solutions)<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2_bfe4baefd957b80ffbee6a64c62fb6d4'><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"J&#039;ai un dossier criminel\"  id='checkbox_2_bfe4baefd957b80ffbee6a64c62fb6d4' aria-label='J&#039;ai un dossier criminel' aria-invalid='false' aria-required=false> <span>J'ai un dossier criminel<\/span><\/label><\/div><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_2_92575777f34fb64e996ba803123b5772'><input  type=\"checkbox\" name=\"checkbox_2[]\" data-name=\"checkbox_2\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"J&#039;ai d\u00e9j\u00e0 \u00e9t\u00e9 annul\u00e9 pour \u00ab non-paiement \u00bb\"  id='checkbox_2_92575777f34fb64e996ba803123b5772' aria-label='J&#039;ai d\u00e9j\u00e0 \u00e9t\u00e9 annul\u00e9 pour \u00ab non-paiement \u00bb' aria-invalid='false' aria-required=false> <span>J'ai d\u00e9j\u00e0 \u00e9t\u00e9 annul\u00e9 pour \u00ab non-paiement \u00bb<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_49_input_text' id='label_ff_49_input_text'>What do you want to insure?<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text\" class=\"ff-el-form-control\" data-name=\"input_text\" id=\"ff_49_input_text\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><div class='step-nav ff_step_nav_last'><button style='float: left;'  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary' aria-label='Previous'>Previous<\/button><button style='float: right;'  type='button' data-action='next' class='ff-float-right ff-btn ff-btn-next ff-btn-secondary' aria-label='Next'>Next<\/button><\/div><\/div><div style='display: none;' class=\" fluentform-step\" data-name=\"form_step-49_2\" ><div class=\"ff-name-address-wrapper fluent-address\" data-type=\"address-element\" data-name=\"address_1\" ><div class='ff-el-input--label'><label aria-label=\"Address\">Address<\/label><\/div><div class='ff-el-input--content'><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_49_address_1_address_line_1_' id='label_ff_49_address_1_address_line_1_'>Address Line 1<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[address_line_1]\" id=\"ff_49_address_1_address_line_1_\" class=\"ff-el-form-control\" placeholder=\"Address Line 1\" data-key_name=\"address_line_1\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_49_address_1_city_' id='label_ff_49_address_1_city_'>Town<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[city]\" id=\"ff_49_address_1_city_\" class=\"ff-el-form-control\" placeholder=\"Town\" data-key_name=\"city\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_49_address_1_state_' id='label_ff_49_address_1_state_'>Province<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[state]\" id=\"ff_49_address_1_state_\" class=\"ff-el-form-control\" placeholder=\"Quebec only\" data-key_name=\"state\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_49_address_1_zip_' id='label_ff_49_address_1_zip_'>Zip code<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[zip]\" id=\"ff_49_address_1_zip_\" class=\"ff-el-form-control\" placeholder=\"Code Postal\" data-key_name=\"zip\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_1\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_49_phone' id='label_ff_49_phone'>Phone\/mobile<\/label><\/div><div class='ff-el-input--content'><input name=\"phone\" class=\"ff-el-form-control ff-el-phone ff_el_with_extended_validation\" type=\"tel\" placeholder=\"###-###-####\" data-name=\"phone\" id=\"ff_49_phone\" inputmode=\"tel\"  aria-invalid='false' aria-required=true><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_49_email' id='label_ff_49_email'>Email<\/label><\/div><div class='ff-el-input--content'><input type=\"email\" name=\"email\" id=\"ff_49_email\" class=\"ff-el-form-control\" placeholder=\"Email\" data-name=\"email\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div class='step-nav ff_step_nav_last'><button style='float: left;'  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary' aria-label='Previous'>Previous<\/button><button style='float: right;'  type='button' data-action='next' class='ff-float-right ff-btn ff-btn-next ff-btn-secondary' aria-label='Next'>Next<\/button><\/div><\/div><div style='display: none;' class=\" fluentform-step\" data-name=\"form_step-49_3\" ><div data-name=\"ff_cn_id_2\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_49_input_text_1' id='label_ff_49_input_text_1'>Current or previous insurer<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_1\" class=\"ff-el-form-control\" data-name=\"input_text_1\" id=\"ff_49_input_text_1\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_49_dropdown_2' id='label_ff_49_dropdown_2'>Are you a smoker?<\/label><\/div><div class='ff-el-input--content'><select name=\"dropdown_2\" id=\"ff_49_dropdown_2\" class=\"ff-el-form-control\" data-name=\"dropdown_2\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=\"false\" aria-labelledby=\"label_ff_49_dropdown_2\"><option value=\"\">- Select -<\/option><option value=\"Fumeur\"  >Smoking<\/option><option value=\"Non fumeur\"  >Non-smoking<\/option><\/select><\/div><\/div><\/div><\/div><div data-name=\"ff_cn_id_3\"  class='ff-t-container ff-column-container ff_columns_total_2 '><div class='ff-t-cell ff-t-column-1' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_49_datetime_1' id='label_ff_49_datetime_1'>Your date of birth<\/label><\/div><div class='ff-el-input--content'><input  aria-label='Your date of birth Use arrow keys to navigate dates. Press enter to select a date.'  aria-haspopup='dialog' data-type-datepicker data-format='d\/m\/Y' type=\"text\" name=\"datetime_1\" id=\"ff_49_datetime_1\" class=\"ff-el-form-control ff-el-datepicker\" data-name=\"datetime_1\"  aria-invalid='false' aria-required=false><\/div><\/div><\/div><div class='ff-t-cell ff-t-column-2' style='flex-basis: 50%;'><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_49_input_text_2' id='label_ff_49_input_text_2'>Your occupation<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_2\" class=\"ff-el-form-control\" data-name=\"input_text_2\" id=\"ff_49_input_text_2\"  aria-invalid=\"false\" aria-required=false><\/div><\/div><\/div><\/div><div class='step-nav ff_step_nav_last'><button style='float: left;'  type='button' data-action='prev' class='ff-btn ff-btn-prev ff-btn-secondary' aria-label='Previous'>Previous<\/button><button style='float: right;'  type='button' data-action='next' class='ff-float-right ff-btn ff-btn-next ff-btn-secondary' aria-label='Next'>Next<\/button><\/div><\/div><div style='display: none;' class=\" fluentform-step\" data-name=\"form_step-49_4\" ><div class='ff-el-group a360-consent'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label  >The information collected in this section allows us, among other things, to pre-qualify for your insurance needs and potentially provide you with an insurance quote. The information provided is stored in order to meet legislative and regulatory requirements. In addition, by filling out the form, you consent to our use, communication or sharing internally and externally (in particular with partner firms and\/or insurers) and that we retain this information.  <\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='checkbox_1_bd306e16567cd376a6bcb70a6d6a54d8'><input  type=\"checkbox\" name=\"checkbox_1[]\" data-name=\"checkbox_1\" class=\"ff-el-form-check-input ff-el-form-check-checkbox\" value=\"J&#039;accepte\"  id='checkbox_1_bd306e16567cd376a6bcb70a6d6a54d8' aria-label='I agree' aria-invalid='false' aria-required=true> <span>I agree<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group a360-consent'><div class=\"ff-el-input--label asterisk-right\"><label  >I would like to subscribe to the Assur360 newsletter for its contests, promotions and information<\/label><\/div><div class='ff-el-input--content'><div class='ff-el-form-check ff-el-form-check-'><label class='ff-el-form-check-label' for='input_radio_1_d79dbbfa6a9a950ff0f24c279c85a44a'><input  type=\"radio\" name=\"input_radio_1\" data-name=\"input_radio_1\" class=\"ff-el-form-check-input ff-el-form-check-radio\" value=\"Oui\"  id='input_radio_1_d79dbbfa6a9a950ff0f24c279c85a44a' aria-label='Yes' aria-invalid='false' aria-required=false> <span>Yes<\/span><\/label><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_49_description' id='label_ff_49_description'>Additional Information<\/label><\/div><div class='ff-el-input--content'><textarea aria-required=\"false\" aria-labelledby=\"label_ff_49_description\" name=\"description\" id=\"ff_49_description\" class=\"ff-el-form-control\" rows=\"3\" cols=\"2\" data-name=\"description\" ><\/textarea><\/div><\/div>        <div class=\"ff-step-t-container ff-inner_submit_container ff-column-container ff_columns_total_2\">\n            <div class=\"ff-t-cell 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