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Please complete and submit the information below and a Licensed Insurance Representative* from CUMIS® will be pleased to contact you to discuss life insurance options suitable for your unique needs. In addition to a competitive quote from CUMIS, quotes from other leading insurers can also be provided.

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Address:   Province:  
City:   Postal Code:    

Phone Number Type:   Phone Number:   Best time to call:  
Credit Union:   Email:    

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By clicking "Submit", I consent to a CUMIS Licensed Insurance Representative contacting me to discuss my insurance needs. I also consent to CUMIS collecting, using and disclosing my contact information to my credit union for the purposes of advising me of products and services that may be of interest and value to me. For further information about CUMIS' privacy practices, please visit