TruSafe GROUP BENEFITS QUOTE REQUEST

GROUP BENEFITS QUOTE REQUEST

PLEASE ALLOW 7-10 BUSINESS DAYS FOR FULL TURN AROUND WHERE WE WILL NEGOTIATE WITH SEVERAL OF THE TOP GROUP BENEFITS PROVIDERS IN CANADA ON YOUR BEHALF
YOUR COMPANY DETAILS*

COMPANY LEGAL NAMEPRIMARY CONTACT
TYPE OF BUSINESSHOW MANY YEARS IN BUSINESS?
YOUR CONTACT INFO*

EMAIL ADDRESSPHONE NUMBER
PREFERRED METHOD OF CONTACT
COMPANY ADDRESS*

Street Address

CityProvince

Postal Code

WHAT SHOULD WE PAY EXTRA ATTENTION TO?

	HIGH IMPORTANCE	SOMEWHAT IMPORTANT	LOW IMPORTANCE
HR SUPPORT
TEAM RETENTION STRATEGIES
PLAN DESIGN
DISABILITY PROTECTION (STD/LTD)
HEALTH CARE/WELLNESS SPENDING ACCOUNTS

FOR TEAMS over 10 lives:

-Please download the census form from the link below
-Once saved to your computer, Please fill out the census
-Please attach saved file in "Browse Files" below

Click Here: Employee Census Data Form Download
Please provide your most recent Renewal Documents as well as any other information you have available such as your Group Benefits Booklet & Team Census (FILLABLE TEAM CENSUS DATA SHEET DOWNLOAD FOR GROUPS 10 OR MORE ABOVE)

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Please Note:

Group Submissions larger than 10 Employees will require our “Team Census Data Sheet”. Please Download or reach out directly to Jesse Raine at 778-808-4430 for assistance.
Please verify that you are human*
Should be Empty:

	Name/Initial	Gender	DOB or AGE	Family/ Single/ Waive	Occupation	Year of Hire	SALARY IF QUOTING DISABILITY OR LIFE INS. MULTIPLIER
1
2
3
4
5
6
7
8
9
10

GROUP BENEFITS QUOTE REQUEST