facsimile - RBC Insurance
Transcription
facsimile - RBC Insurance
FACSIMILE RBC Life Insurance Company P.O. Box 515, Station “A” Mississauga, ON L5A 4M3 Date: ______________________________ To: LabOne Re: Telephone Application Process Fax #: 1-800-235-2098 Tel: 1-888-881-7712 # Of Pages (including cover sheet): ________ Proposed Insured’s Name: _______________________________________________ Application Serial #: ___________________ Agency: _____________________ Representative’s Name: ____________________________ Code: __________ Representative’s Telephone Number: _______________________________________ Please indicate the product type: Destiny® T10 T20 > Destiny - Face amounts of $250, 001 and up for ages 41 and above Face amounts of $500, 001 and up for ages 0-40 > Term 10 & 20 – All face amounts Please indicate the service company you wish to use for the following: Fluid Collection, tests and medicals Hooper Holmes/Portamedic Bodimetrics/Quality Underwriting Medisys Medifast ExamOne No Preference Inspection Reports First Financial Hooper Holmes/Portamedic Keyfacts Intellisys Quality Underwriting ExamOne No Preference This fax may be privileged and/or confidential, and the sender does not waive any related rights and obligations. Any distribution, use or copying of this fax or the information it contains by other than an intended recipient is unauthorized. If you received this fax in error, please advise the sender (by return fax or otherwise) immediately. Cette transmission est confidentielle et protégée. L’expéditeur ne renonce pas aux droits et obligations qui s’y rapportent. Toute diffusion, utilisation ou copie de ce message ou des renseignements qu’il contient par une personne autre que le (les) destinataire(s) désignés est interdite. Si vous recevez cette transmission par erreur, veuillez m’en aviser immédiatement, par retour de transmission ou par un autre moyen.