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Province/Territory of Residence British Columbia Alberta Saskatchewan Northewest Territories Yukon Territory Nunavit Manitoba Ontario Quebec Nova Scotia New Brunswick Prince Edward Island Newfoundland Insurance Type 5 Year Term 10 Year Term 15 Year Term 20 Year Term 25 Year Term 30 Year Term 35 Year Term Level term to 65 Level term to 70 Level term to 75 Special Term Traditional Term 100 Unique Term 100 Single Person Funeral Plan Health Risk Super Preferred Preferred Select Regular Regular Premium $ 25,000 $ 30,000 $ 35,000 $ 40,000 $ 45,000 $ 50,000 $ 55,000 $ 60,000 $ 65,000 $ 70,000 $ 75,000 $ 80,000 $ 85,000 $ 90,000 $ 95,000 $ 100,000 $ 125,000 $ 150,000 $ 175,000 $ 200,000 $ 225,000 $ 250,000 $ 275,000 $ 300,000 $ 325,000 $ 350,000 $ 375,000 $ 400,000 $ 425,000 $ 450,000 $ 475,000 $ 500,000 $ 550,000 $ 600,000 $ 650,000 $ 700,000 $ 750,000 $ 800,000 $ 850,000 $ 900,000 $ 950,000 $1,000,000 $1,250,000 $1,500,000 $1,750,000 $2,000,000 $2,250,000 $2,500,000 $2,750,000 $3,000,000 $3,500,000 $4,000,000 $4,500,000 $5,000,000 $6,000,000 $7,000,000 $8,000,000 $9,000,000 $10,000,000 $11,000,000 $12,000,000 $13,000,000 $14,000,000 $15,000,000 $16,000,000 $17,000,000 $18,000,000 $19,000,000 $20,000,000 $21,000,000 $22,000,000 $23,000,000 $24,000,000 $25,000,000 $26,000,000 $27,000,000 $28,000,000 $29,000,000 $30,000,000 Annual Semi-Annual Quarterly Monthly Date of Birth January Febuary March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1942 1943 1944 1945 1946 1947 1948 1949 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 Sex MaleFemale Have you ever used tobacco or tobacco substitutes ? YesNo Cigarette Never last 12 months More than 1 yr More than 2 yrs More than 3 yrs More than 4 yrs More than 5 yrs More than 6 yrs More than 10 yrs More than 15 yrs More than 25 yrs Cigar Never last 12 months More than 1 yr More than 2 yrs More than 3 yrs More than 4 yrs More than 5 yrs More than 6 yrs More than 10 yrs More than 15 yrs More than 25 yrs Pipe Never last 12 months More than 1 yr More than 2 yrs More than 3 yrs More than 4 yrs More than 5 yrs More than 6 yrs More than 10 yrs More than 15 yrs More than 25 yrs Snuff Never last 12 months More than 1 yr More than 2 yrs More than 3 yrs More than 4 yrs More than 5 yrs More than 6 yrs More than 10 yrs More than 15 yrs More than 25 yrs Cigarello Never last 12 months More than 1 yr More than 2 yrs More than 3 yrs More than 4 yrs More than 5 yrs More than 6 yrs More than 10 yrs More than 15 yrs More than 25 yrs Chew Never last 12 months Marijuana Never last 12 months More than 1 yr More than 2 yrs More than 3 yrs More than 4 yrs More than 5 yrs More than 6 yrs More than 10 yrs More than 15 yrs More than 25 yrs Prescribed Never last 12 months More than 1 yr More than 2 yrs More than 3 yrs More than 4 yrs More than 5 yrs More than 6 yrs More than 10 yrs More than 15 yrs More than 25 yrs

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