Apply Online - JONES DesLauriers Blevins

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New Applicant

If you are a new customer and wish to apply online, please click the New Application button below. You will be prompted to answer a few easy questions to get a quote, then simply select a plan to start your application.

New Application

Apply Manually

If you would prefer to fill out a paper application and submit it by mail, please print the PDF provided below.

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Advisor Information

Please use the information below to complete the advisor fields. That way we’ll know who sent you to us.

Advisor Code

N7501

Office Code

GS334

MGA Code

5243

Advisor Name

Frank Shahrokhi

Office Name

JONES DesLauriers Blevins (CMCC)

MGA Name

Jones Deslauriers Blevins

Application Forms (PDF)

Download the form for the plan you are interested in applying for:

ZONE Plan Application Form Learn More about ZONE Plans

LINK Plan Application Form Learn More about LINK Plans

Plans are provided and underwritten by Green Shield Canada Insurance.

You are eligible to apply for GreenShield Insurance plans as long as you are a Canadian resident, you have valid provincial health insurance plan coverage (Quebec residents must also have RAMQ), and you are under 80 years of age.

Rates and/or benefits are subject to change; GreenShield will provide policy owners with thirty (30) days written notice.

This is not a contract. This is a summary and does not constitute a contract. Actual terms, conditions, limitations, and exclusions are detailed in the contract issued by Green Shield Canada Insurance upon application approval. All maximums shown are in Canadian dollars, per covered person.

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