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Fransajeunesse – Education Saving & Insurance Plan Application

Fields that are marked with * are required.
Personal Information
Gender Applicant Title
First Name*
Family Name*
Father’s name*
Maiden name*
Date of birth*
Mobile Number*
Language
Application Details
Target (Capital to be saved)*
or Annual Premium (min. $300)*
Premium frequency*
Annual premium variation (2 to 10%) - Optional
Dependent gender Dependent name*
Dependant Age at Maturity*
Dependant date of birth*
Schooling Option Annualized schooling amount (Between $500 and $6.000)
Annual variation on schooling amount (2 to 10%) - Optional
Payment of schooling amount (quarterly or annually)
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