J’assure ma cause application form

You explored our financing solution and want to take the next step?
If your organization is ready to take the first step into this new and simple way to raise funds and multiply its donations thanks to life insurance, join the J’assure ma cause movement.

Information about your organization

Complete all fields of the form to submit your adhesion application.

Name of the organization:*

Registration number:*

Address:*

City:*

Province:*

Postal code:*

What services do you offer?*

Signatories authorized to sign electronic proposals

First authorized signatory (you)

First name:*

Last name:*

Position in the organization:*

Telephone:*

Email:*

Second authorized signatory

First name:*

Last name:*

Position in the organization:*

Telephone:*

Email:*

Signature*Please enter your full name below. You acknowledge that the writing of your name below represents your official signature and validates this form.

We acknowledge that the information provided in this form is accurate.*

We agree to notify J’assure ma cause of any changes to our contact information.*

If our application is approved, we agree to sign a partnership agreement and pay the annual subscription fee of $375 + taxes. We also agree to provide J’assure ma cause with a specimen cheque.*

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J’assure ma cause application form

Information about your organization

1 833 488-3003