Welcome to Holman Insurance Brokers on-line Personal Life Insurance quick quote page. Please ensure you complete the form as accurately as possible in order to ensure the best possible estimate. If you would rather speak to one of our sales representatives, please call us at (905) 886-5630 or 1-800-567-1279.

Completion of this form is for informational purposes only, and is just an estimate.
This WILL NOT result in a new policy, or change to an existing policy.

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Contact Information
First Name*
Last Name*
Address*
Phone*
City*
Phone 2
Province*
E-Mail*
Postal Code*
Contact Method
Phone Email
Employer
Occupation
Insurance Information
Are you presently insured? If yes, what company?* (enter "none" if answer is no)
Policy Number* (enter "none" if you do not have a policy number)
Expiry Date
What is your current annual premium?
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Why are you looking for a new insurer or broker?
Personal Information
Date of Birth
Which best describes your tobacco history?
Gender
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What is the amount of insurance requested?
 
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Thank you for trusting Holman Insurance Brokers Ltd. for your insurance needs, one of our representatives will contact you soon with your quote!
Personal Life Quote