Employment Status Salaried Employee Contract Worker Self Employed
Do You Contribute to Unemployment Insurance? Yes No
Do You Contribute to WSIB? No Yes
How Long Have You Been Self-Employed? Less Than 1 Year 1 to 2 Years 3 -5 Years 5 – 10 Years 10+ Years
Hoe Long Have You Been with Your Current Employer? Less Than 1 Year 1 to 2 Years 3 -5 Years 5 – 10 Years 10+ Years
Last Years Income $0 – $20,000 $20,000 – $25,000 $25,000 – $30,000 $30,000 – $40,000 $40,000 – $50,000 $50,000 – $65,000 $65,000 – $80,000 $80,000 – $100,000 $100,000 – $125,000 $125,000 – $150,000 $150,000 – $200,000 $200,000 – $250,000 $250,000+ I prefer not to say
Income the Year Before Last $0 – $20,000 $20,000 – $25,000 $25,000 – $30,000 $30,000 – $40,000 $40,000 – $50,000 $50,000 – $65,000 $65,000 – $80,000 $80,000 – $100,000 $100,000 – $125,000 $125,000 – $150,000 $150,000 – $200,000 $200,000 – $250,000 $250,000+ I prefer not to say
Would You Like a Lump Sum Payout in the Event that Your Death is Accidental? No Yes
Amount of Accidental Death & Dismemberment Coverage $5,000 $10,000 $25,000 $50,000 $100,000 $250,000 $500,000 As much as possible
What Percentage of Your Income Would You Like to Cover? 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
Do You Have Medical Complications? No Yes I Prefer Not to Say
Have You Ever Been Unable to Practice Your Occupation For More Than 2 Weeks Because of Disability? No Yes
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