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Province Quebec Tobacco use (Ever?)Yes No

	Cigarette Never within 12 months more than 1 yr ago more than 2 yrs ago more than 3 yrs ago more than 4 yrs ago more than 5 yrs ago more than 6 yrs ago more than 10 yrs ago more than 15 yrs ago more than 25 yrs ago Cigar Never within 12 months more than 1 yr ago more than 2 yrs ago more than 3 yrs ago more than 4 yrs ago more than 5 yrs ago more than 6 yrs ago more than 10 yrs ago more than 15 yrs ago more than 25 yrs ago Cigarello Never within 12 months more than 1 yr ago more than 2 yrs ago more than 3 yrs ago more than 4 yrs ago more than 5 yrs ago more than 6 yrs ago more than 10 yrs ago more than 15 yrs ago more than 25 yrs ago Pipe Never within 12 months more than 1 yr ago more than 2 yrs ago more than 3 yrs ago more than 4 yrs ago more than 5 yrs ago more than 6 yrs ago more than 10 yrs ago more than 15 yrs ago more than 25 yrs ago Chew Never within 12 months more than 1 yr ago more than 2 yrs ago more than 3 yrs ago more than 4 yrs ago more than 5 yrs ago more than 6 yrs ago more than 10 yrs ago more than 15 yrs ago more than 25 yrs ago Other Never within 12 months more than 1 yr ago more than 2 yrs ago more than 3 yrs ago more than 4 yrs ago more than 5 yrs ago more than 6 yrs ago more than 10 yrs ago more than 15 yrs ago more than 25 yrs ago Marijuana Never within 12 months more than 1 yr ago more than 2 yrs ago more than 3 yrs ago more than 4 yrs ago more than 5 yrs ago more than 6 yrs ago more than 10 yrs ago more than 15 yrs ago more than 25 yrs ago Vapor / E-Cigarette Never within 12 months more than 1 yr ago more than 2 yrs ago more than 3 yrs ago more than 4 yrs ago more than 5 yrs ago more than 6 yrs ago more than 10 yrs ago more than 15 yrs ago more than 25 yrs ago Water / Spritual Pipe Never within 12 months more than 1 yr ago more than 2 yrs ago more than 3 yrs ago more than 4 yrs ago more than 5 yrs ago more than 6 yrs ago more than 10 yrs ago more than 15 yrs ago more than 25 yrs ago

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Face Amount	Face Amount $ 25,000 $ 30,000 $ 35,000 $ 40,000 $ 45,000 $ 50,000 $ 55,000 $ 60,000 $ 65,000 $ 70,000 $ 75,000 $ 80,000 $ 85,000 $ 90,000 $ 95,000 $ 100,000 $ 125,000 $ 150,000 $ 175,000 $ 200,000 $ 225,000 $ 250,000 $ 275,000 $ 300,000 $ 325,000 $ 350,000 $ 375,000 $ 400,000 $ 425,000 $ 450,000 $ 475,000 $ 500,000 $ 550,000 $ 600,000 $ 650,000 $ 700,000 $ 750,000 $ 800,000 $ 850,000 $ 900,000 $ 950,000 $1,000,000 $1,250,000 $1,500,000 $1,750,000 $2,000,000 $2,250,000 $2,500,000 $2,750,000 $3,000,000 $3,500,000 $4,000,000 $4,500,000 $5,000,000 $6,000,000 $7,000,000 $8,000,000 $9,000,000 $10,000,000 $11,000,000 $12,000,000 $13,000,000 $14,000,000 $15,000,000 $16,000,000 $17,000,000 $18,000,000 $19,000,000 $20,000,000 $21,000,000 $22,000,000 $23,000,000 $24,000,000 $25,000,000 $26,000,000 $27,000,000 $28,000,000 $29,000,000 $30,000,000
Product Type	1 year Term 10 year Term 15 year Term 20 year Term 25 Year Term 30 Year Term 35 Year Term 40 Year Term Level term to 65 Level term to 70 Level term to 75 Unique Term OptiTerm Traditional Term 100 T100 20-Pay Unique Term 100 Whole Life / Life Pay Whole Life / Pay to 65 Whole Life / 25 Pay Whole Life / 20 Pay Whole Life / 15 Pay Whole Life / Quick Pay Unique Whole Life Living Benefits Single Person Funeral Plan 10 year Term 11 year Term 12 year Term 13 Year Term 14 Year Term 15 Year Term 16 Year Term 17 Year Term 18 Year Term 19 Year Term 20 year Term 21 year Term 22 year Term 23 Year Term 24 Year Term 25 Year Term 26 Year Term 27 Year Term 28 Year Term 29 Year Term 30 year Term 31 year Term 32 year Term 33 Year Term 34 Year Term 35 Year Term 36 Year Term 37 Year Term 38 Year Term 39 Year Term 40 year Term CI / Term 10 CI / Term 15 CI / Term 20 CI / Term 25 CI / Term 30 CI / Term 65 CI / Term 70 CI / Term 75 CI / T100 - Life Pay CI / T100 - Pay to 65 CI / T100 - 10-20 Pay CI / Cond. limited Pay CI / Decreasing Comb Life & CI/25% Comb Life & CI/50% Comb Life & CI/75%
Select the Critical Illnesses that need to be covered by the quoted products: Heart Attack Cancer Stroke Acquired Brain Injury Alzheimer's Disease Aortic Surgery Aplastic Anaemia Autism Bacterial Meningitis Benign Brain Tumour Blindness Cerebral Palsy Coma Congenital Heart Disease Coronary Angioplasty Coronary Artery Surgery Cystic Fibrosis Deafness Dismemberment Heart Surgery Heart Valve Replacement Kidney (Renal) Failure Loss of Independence Loss of Limbs Loss of Speech Major/Vital Organ Failure/Transplant Motor Neuron /Lou Gehrig's Disease Multiple Sclerosis Muscular Dystrophy Occupational HIV Paralysis Parkinson's Disease Rett Syndrome Severe Burns Type 1 Diabetes Mellitus

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