Barrons Financial Advisory Services

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Date of Birth		Gender
Mailing Address
City		Province
Postal Code		Country
Smoker
Occupation
Describe the work you do (e.g. manual labour, at a desk, etc.):
How Long have you been in this line of work:		Employment Type
If in a partnership, what percentage is yours?		If self-employed, how long have you owned the business?
If employed, how long have you been with your present employer?
How much do you make in		Salary: $
Commission: $		Bonus: $
What was your income last year?		What was your income two years ago?
Are you covered by Workers Safety Insurance Board?		Are you eligible for Employment Insurance Sick Benefits?
How much disability insurance are you looking to receive? (2/3 of income is typical)		Waiting Period (3,2 or 1 months? Other?)
Benefit Period (To age 65 or for 5 years?)
Other Comments:

Mailing Address