Please complete the form below so we can determine your eligibility for Disability (Loss of Income) coverage.

Do NOT include SIN or sensitive account numbers.

Full Name *

Date of birth

Email *

Mobile Number *

City and Province *

Gender

Marital Status

Preferred Language: *

English

Français

Either

When do you expect to buy *

1-3 months

4-6 months

After 6 months

Just checking if I qualify

Consent to be contacted *

I agree that a representative from JK Infinite Solutions may contact me by phone, email, or text message to discuss my financial needs and potential solutions.

CASL / marketing consent *

I would like to receive educational content, invitations to webinars, and updates about financial strategies and services. I understand I can unsubscribe at any time.

Privacy Policy | Terms of Service

This pre-screen form is for eligibility evaluation only and does not constitute an offer, quote, or guarantee of approval. Please do not enter any SIN or sensitive information. All coverage is subject to provincial licensing, underwriting guidelines, and carrier approval.