Are you a Scotiabank customer and a Canadian resident?
Are you between the ages of 18-74?
Do you currently have ScotiaLife Complimentary Accidental Death Coverage?
* Required fields
Your Name
First Name * Initial Last Name *
Home Address
Street No. Street Name * Unit Type Unit No.
City * Province/Territory * Postal Code *
This product is currently not available to residents of QC and NU.
Phone Number
Home Phone Number * Work Phone Number

Enter your email address below to receive electronic messages from us, including messages about our products and services.
Email Address
Date of Birth: * Month Day Year
Gender: * Male Female
Your Spouse’s Name (if enrolling)
Spouse’s First Name * Initial Spouse’s Last Name *
Is your Spouse a Canadian resident? *
Spouse’s Date of Birth: * Month Day Year
Spouse’s Gender: * Male Female

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