{"id":32,"date":"2018-09-01T07:09:40","date_gmt":"2018-09-01T07:09:40","guid":{"rendered":"http:\/\/dayainsurance.ca\/?p=32"},"modified":"2018-09-01T07:12:14","modified_gmt":"2018-09-01T07:12:14","slug":"non-medical-insurance-free-quote","status":"publish","type":"post","link":"https:\/\/economicalfinancial.com\/?p=32","title":{"rendered":"Non-medical Insurance Free Quote"},"content":{"rendered":"\n<div class=\"wpcf7 no-js\" id=\"wpcf7-f54-o1\" lang=\"en-US\" dir=\"ltr\" data-wpcf7-id=\"54\">\n<div class=\"screen-reader-response\"><p role=\"status\" aria-live=\"polite\" aria-atomic=\"true\"><\/p> <ul><\/ul><\/div>\n<form action=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fposts%2F32#wpcf7-f54-o1\" method=\"post\" class=\"wpcf7-form init\" aria-label=\"Contact form\" novalidate=\"novalidate\" data-status=\"init\">\n<fieldset class=\"hidden-fields-container\"><input type=\"hidden\" name=\"_wpcf7\" value=\"54\" \/><input type=\"hidden\" name=\"_wpcf7_version\" value=\"6.1.5\" \/><input type=\"hidden\" name=\"_wpcf7_locale\" value=\"en_US\" \/><input type=\"hidden\" name=\"_wpcf7_unit_tag\" value=\"wpcf7-f54-o1\" \/><input type=\"hidden\" name=\"_wpcf7_container_post\" value=\"0\" \/><input type=\"hidden\" name=\"_wpcf7_posted_data_hash\" value=\"\" \/>\n<\/fieldset>\n<p><label>1. Have you lived in Canada for less than 12 months ?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"select1\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"select1\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"yes\">yes<\/option><option value=\"no\">no<\/option><\/select><\/span><\/label><br \/>\n<hr \/><br \/>\n<label>2. In the past two years, have you had an application for critical illness insurance declined or postponed by any company, including Industrial Alliance ?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"select2\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"select2\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"yes\">yes<\/option><option value=\"no\">no<\/option><\/select><\/span><\/label><br \/>\n<hr \/><br \/>\n<label>3. Do you currently suffer from, or have you ever suffered from or had symptoms of any of the following illnesses or ailments, or have you ever consulted a doctor or been treated for: <\/label><br \/>\n<label> a) Congenital cardiac defects, angina, angioplasty, coronary artery bypass, heart attack, congestive heart failure, stroke, transient ischemic attack (TIA) or any other cerebrovascular disease or disease of the heart or the blood vessels, or an abnormal electrocardiogram (ECG) ?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"select3\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"select3\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"yes\">yes<\/option><option value=\"no\">no<\/option><\/select><\/span> <\/label><br \/>\n<label> b) Type 1 (insulin-dependent) diabetes or type 2 diabetes ?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"select4\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"select4\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"yes\">yes<\/option><option value=\"no\">no<\/option><\/select><\/span> <\/label><br \/>\n<label> c) Cancer or other malignant disease, tumour, colon polyp or any other growth ?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"select5\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"select5\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"yes\">yes<\/option><option value=\"no\">no<\/option><\/select><\/span> <\/label><br \/>\n<label> d) Any breast problems (mass, cyst, unusual discharge, physical change, abnormal mammogram or biopsy) or prostate problems (nodule or abnormal PSA) ?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"select6\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"select6\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"yes\">yes<\/option><option value=\"no\">no<\/option><\/select><\/span> <\/label><br \/>\n<hr \/><br \/>\n<label>4.<br \/>\na) Currently, are you under medical investigation or have you been advised to undergo a diagnostic test or surgery that has not yet been carried out ?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"select7\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"select7\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"yes\">yes<\/option><option value=\"no\">no<\/option><\/select><\/span> <\/label><br \/>\n<label> b) Have you noticed any symptoms or health problems for which you have not yet consulted a doctor, such as: abnormality, lump or mass on the breasts, shortness of breath, chest pain, dizziness, loss of balance, numbness, rectal bleeding, prostate or other problems ?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"select8\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"select8\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"yes\">yes<\/option><option value=\"no\">no<\/option><\/select><\/span> <\/label><br \/>\n<hr \/><br \/>\n<label>5. Have you tested positive for or received test results that indicate the presence of any one of the following diseases:<\/label><br \/>\n<label> a) HIV (AIDS virus), AIDS or other AIDS-related illness ?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"select9\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"select9\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"yes\">yes<\/option><option value=\"no\">no<\/option><\/select><\/span> <\/label><br \/>\n<label> b) Hepatitis B or C, chronic type D hepatitis, or carrier of hepatitis B ?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"select10\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"select10\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"yes\">yes<\/option><option value=\"no\">no<\/option><\/select><\/span> <\/label><br \/>\n<hr \/><br \/>\n<label>6. In the last five years, have you undergone detoxication treatment (in-patient or out-patient treatment program) for alcohol or drug use ?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"select11\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"select11\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"yes\">yes<\/option><option value=\"no\">no<\/option><\/select><\/span> <\/label><br \/>\n<hr \/><br \/>\n<label> 7. In the last five years, have you used any hard drugs such as opium, heroin, morphine, codeine, Demerol, barbiturates, amphetamines, cocaine, hallucinogens or anabolic steroids, other than as prescribed by a doctor, or methadone, whether prescribed by a doctor or not ?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"select12\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"select12\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"yes\">yes<\/option><option value=\"no\">no<\/option><\/select><\/span> <\/label><br \/>\n<hr \/><br \/>\n<label>8. Family History Do two (2) or more members of your immediate family (father, mother, brothers, sisters) suffer from, or have they suffered from cancer, heart disease, stroke or transient ischemic attack (TIA) before the age of 60 ?<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"select13\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"select13\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"yes\">yes<\/option><option value=\"no\">no<\/option><\/select><\/span> <\/label><br \/>\n<hr \/><br \/>\n<label> 9. Does your current weight exceed the weight indicated for your height in the table below ?<span class=\"wpcf7-form-control-wrap\" data-name=\"select14\"><select class=\"wpcf7-form-control wpcf7-select wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" name=\"select14\"><option value=\"\">&#8212;Please choose an option&#8212;<\/option><option value=\"yes\">yes<\/option><option value=\"no\">no<\/option><\/select><\/span> <\/label><br \/>\n<hr \/>\n<\/p>\n<div class=\"row\">\n\t<p><label class=\"col-sm-6\"> Name<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-name\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-text wpcf7-validates-as-required\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"text\" name=\"your-name\" \/><\/span> <\/label><label class=\"col-sm-6\"> Phone<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-phone\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"your-phone\" \/><\/span> <\/label>\n\t<\/p>\n<\/div>\n<div class=\"row\">\n\t<p><label class=\"col-sm-6\"> Mobile No.<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-mobile\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-tel wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-tel\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"tel\" name=\"your-mobile\" \/><\/span> <\/label><label class=\"col-sm-6\">Email<br \/>\n<span class=\"wpcf7-form-control-wrap\" data-name=\"your-email\"><input size=\"40\" maxlength=\"400\" class=\"wpcf7-form-control wpcf7-email wpcf7-validates-as-required wpcf7-text wpcf7-validates-as-email\" aria-required=\"true\" aria-invalid=\"false\" value=\"\" type=\"email\" name=\"your-email\" \/><\/span><\/label>\n\t<\/p>\n<\/div>\n<div class=\"clearfix\">\n<\/div>\n<p>[cf7sr-simple-recaptcha]\n<\/p>\n<p><input class=\"wpcf7-form-control wpcf7-submit has-spinner\" type=\"submit\" value=\"Send\" \/>\n<\/p><div class=\"wpcf7-response-output\" aria-hidden=\"true\"><\/div>\n<\/form>\n<\/div>\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4],"tags":[],"class_list":["post-32","post","type-post","status-publish","format-standard","hentry","category-life-insurance"],"_links":{"self":[{"href":"https:\/\/economicalfinancial.com\/index.php?rest_route=\/wp\/v2\/posts\/32","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/economicalfinancial.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/economicalfinancial.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/economicalfinancial.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/economicalfinancial.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=32"}],"version-history":[{"count":3,"href":"https:\/\/economicalfinancial.com\/index.php?rest_route=\/wp\/v2\/posts\/32\/revisions"}],"predecessor-version":[{"id":300,"href":"https:\/\/economicalfinancial.com\/index.php?rest_route=\/wp\/v2\/posts\/32\/revisions\/300"}],"wp:attachment":[{"href":"https:\/\/economicalfinancial.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=32"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/economicalfinancial.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=32"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/economicalfinancial.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=32"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}