Getting a group insurance quote from GPM is a simple and confidential process. We meet with you only once and our initial proposal remains confidential.

Get started by filling out this form. We will provide you with a quote and a GPM consultant will get in touch with you shortly.

Company Name *

Address

City

Province *

Postal Code

Your Name *

Your Position *

Your Email *

Your Telephone *

Does your company currently have a group insurance plan? *

Yes No 

If Yes, who is your current insurer?

If Yes, when is your renewal date?

Number of Employees for Health:

Single

Single Parent

Couple

Family

Number of Employees for Dental:

Single

Single Parent

Couple

Family

Total paid claims (last 12 months of last year renewal) excluding pooled claims (travel, stop loss and pooling):

Medical $

Dental $

Other Benefits required:

Life InsuranceYes No 

Life for dependantYes No 

Weekly IndemnityYes No 

Long Term DisabilityYes No 

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