How To Use The Rebalancing Beneficiaries Quotation Form

Rebalancing Beneficiaries Support Insurance allows an insurance policy to secure your support payments while allowing additional beneficiaries such as children or a new partner to be included on the policy.

  1. If you are a co-parent or ex-spouse, please complete your personal insurance requirements below.
  2. If you are a Professional, who is completing the information for your client, please provide your business information and your client’s personal information below.
  3. Please consider the specific requirements for Life Insurance, Critical Illness Insurance and Long-Term Disability. Your questions can be explained more fully by a licensed Insurance Advisor or on the websites for our participating Insurance Companies.
  4. When you press the Submit For A Quote button your information will be forwarded to Come To Agreement’s Insurance Department and email addresses on the Quotation Form will be copied for your records.

Type of Life Insurance

Term Life Insurance has a low initial cost and provides coverage at a comparatively modest cost. This can be useful if you only need insurance for a short time, such as while you have support obligations. Term insurance premiums typically increase over time and only pay a benefit if you pass away during a specified time. Term insurance does not build up cash value.

Critical Illness Insurance is a form of health insurance protection that provides a lump sum benefit should you survive a serious illness or condition covered by your policy. Illnesses such as Cancer, Heart Attack or Stroke can have an impact on you, your ex-spouse and family, on an emotional and financial level. Critical Illness coverage provides a lump sum of cash to help with your support obligations and financial needs.

Form Errors

Separation & Divorce Insurance (Quotation Form)

* To Save My Quotation, please Login or Sign Up
Please select if you are a Co-Parent / Ex-Spouse or a Professional:
I am a Co-Parent / Ex-Spouse I am a Professional

Professional Info

Email Address:

Insurance Specifics

Type of Life Insurance:
Length of Coverage:
Amount of Insurance:
Amount for Critical Illness:
Premiums Paid:

Personal Information

Who referred you?
First Name:
Last Name
Email Address:
Phone: (Office)
Phone: (Home/Cell)
Address 1:
Address 2:
ZIP/Postal Code
Birth Date:
Do you smoke? Yes No
Have you smoked within the last 12 months? Yes No
Health Class: Excellent Good Average Poor
Medical Health Notes (Optional)
Do you currently have life insurance? Yes No
Feet/Inches Meter/cm
Pounds (lbs) Kilos (kg)

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Come To Agreement is committed to protect your personal and professional information according to our Privacy Policy as required by government regulations. Come To Agreement will take all reasonable measures to protect your privacy when you use this Service. Our Terms of Use ensures all personal information and data will not be sold, traded or given away for any reason, whatsoever.


Come To Agreement’s Separation & Divorce Insurance Calculator does not replace the advice from a Family Attorney/Lawyer, Family Mediator, Insurance Advisor, Financial Planner or an Accountant. Our representatives do not provide professional advice unless licensed to do so. Prospective clients should contact a Professional regarding their financial or legal situation. The support calculators and insurance calculators are designed to be informational and illustrative tools only and are not intended as professional advice. We cannot and do not guarantee their completeness, applicability or accuracy with regard to your individual circumstances. We strongly recommend you seek the advice of a professional before making any legal, financial or insurance decisions.