Please fill out the form below so we can assess your eligibility and recommend the right Health & Dental plan for your family.

Do NOT include SIN or any 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.

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This form is for assessment only and does not guarantee approval. All coverage is subject to underwriting rules, carrier eligibility, and provincial regulations. Do not include SIN or sensitive information.