Current Client Contact Information

Request changes to your services or submit changes to your contact information by filling out the information below.

A* denotes manditory fields.

Name*
What’s the best way to contact you?
Email
Telephone

Changes to Contact Information

Fill in any information that has changed, leave the rest blank.
Home address
Work address
Home telephone number
Work telephone number
Cell-phone number
Fax number
Pager number
Email address
Banking information *please fax a copy of a void cheque to secure fax number 905-882-7778 attn: Rosanna Garisto or contact me via telephone. Please do not send banking details via email/internet.

Changes to Work Information

Check off any information that has changed or you would like to review and I will contact you immediately.
I have changed jobs
I have started my own business
I have purchased a business/practice
I have incorporated
I have entered into a partnership

Personal Information
I have changed my marital status
I have changed my name
I have had a baby
I am expecting a baby
I have adopted a baby
I have purchased a new home
I am going back to school

Policy Holder services
I would like to change the beneficiary on my policy
I would like to transfer the ownership of my policy to my corporation/other
I need to a complete a collateral assignment form for my financial institution
I would like to review my:
I would like a full review of my portfolio

I would like more information on
Life Insurance




Disability Insurance
Critical Illness Insurance
Long Term Care Insurance
Mortgage Insurance
Financial Planning (RRSP’s, TFSA’s, Investment Options etc.)

Please contact my:
Accountant
Lawyer
Banking Representative

I have other items I would to discuss with you, please contact me immediately