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Get a Quote - Group Benefits

    First Name

    Last Name

    Email

    Telephone

    Company Name

    Subject

    Renewal Date

    Present Insurer

    Duration

    Employee Name

    Sex

    Coverage:(S/F/CTS)

    Date of Birth:
    MM/DD/YYYY

    Annual
    Earnings

    Hours/Week

    Occupation

    Hire Date:
    MM/DD/YYYY

    Province

    Your Message

    Values for Health & Dental Coverage Are:

    S- Single

    F- Family

    CTS- Covered Through Spouse

    Checklist for Companies with Group Coverage:

    We will need a copy of your

    1. Current Benefit Booklet

    2. Most recent Renewal

    3. Employee Census (above)

    Please Return To:

    John Glynn
    Advisor, Barclay Insurance
    P: (604) 398-2399
    F: (604) 687-1554
    E: john@barclayinsurance.ca

    Get a Quote - Individual

      First Name

      Last Name

      Email

      Telephone

      Company

      Type of Insurance

      Date of Birth

      Amount of Coverage

      Smoker Status

      Your Message

      Get a Quote - Business

        First Name

        Last Name

        Email

        Telephone

        Company

        Type of Insurance

        Date of Birth

        Amount of Coverage

        Smoker Status

        Your Message

        Barclay Insurance Services Inc.
        #1501 - 1111 West Georgia St.
        Vancouver, BC V6E 4M3

        Tel: (604) 685-3707

        Fax: (604) 687-1554

        Email: info@barclayinsurance.ca

        Barclay insurance
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