Important:
- If you should print the following forms, please make sure of its quality and take into account the number of copies required, when applicable.
- To access the French version of the forms, select "Français" on the upper right hand side of your screen.
- Individual Insurance
- Group Insurance
Individual Insurance
All Provinces except Quebec
Authorization for the Collection and Communication of Personal Information - Disability - 98185E02 (03-07)
1 page - 33 kb
Authorization for the Collection and Communication of Personal Information - Death - 98185E03 (12-01)
1 page - 440 kb
Claim - Individual Insurance (Accidental Dismemberment or Loss of Sight, Fractures) - 0303101A (11-04)
2 pages - 57 kb
Claim - Total Long-term Care - 06223E01 (12-03)
6 pages - 136 kb
Claimant's Statement - Death - Annuities - 98183E (07-08)
1 page - 107 kb
Claimant's Statement - Death Claim - 98069E01 (09-03)
1 page - 84 kb
Claimant's Statement for Joint Second Death Plans - 16E
1 page - 39 kb
Critical Illness Claim form - 1702504A (09-03)
2 pages - 48 kb
Critical Illness Claim form (Attending Physician's Statement) - 1702601A (08-12)
2 pages - 120 kb
Claim for Health Care Benefits - SOLO Health (sold before October 25
, 2010) - 1913212A (11-05) - Electronic form
2 pages - 226 kb
Claim for Health Care Benefits - SOLO Healthcare (sold as of October 25, 2010) - 1913216A (11-05) - Electronic form
2 pages - 212 kb
Disability Claim - Employer or Self-Employed Individual's Statements -
0202452A (06-03)
1 page - 123 kb
Disability Claim - Individual - 0202451A (12-03)
2 pages - 94 kb
Income Replacement Benefits - Attending Physician's Statement - 05009E (09-07)
2 pages - 454 kb
Physical or Psychological Illnesses - Original Request - 020259A (09-12)
2 pages - 259 kb
Physical or Psychological Illnesses - Additional Report - 020269A (09-12)
2 pages - 209 kb
Proof of Death - Physician's Statement - 98083E01 (10-08)
1 page - 81 kb
Proof of Disability - 3523L (07-06)
2 pages - 162 kb
RACQ - Physical or Psychological Illnesses - Original Request - 0202501A (09-12)
2 pages - 208 kb
RACQ - Physical or Psychological Illnesses - Additional Report - 0202601A (09-12)
2 pages - 256 kb
Total Disability Benefits Claim - Insured Person's Statement - 0301101A (10-08) - Electronic Form
2 pages - 214 kb
SOLO - Disability Claim - 09044E01 (09-05)
4 pages - 156 kb
SOLO - Additional Statement - 09045E01 (09-05)
1 page - 72 kb
SOLO - Business Expense Statement - 09110E01 (09-05)
1 page - 77 kb
SOLO - Detailed Statement of Overhead Expenses and Income Earned in the Case of Residual Disability - 09111E01 (09-05)
1 page - 80 kb
Quebec
Application for Reimbursement - Business Expense Insurance - 02805A (07-02)
1 page - 50 kb
Authorization for the Collection and Communication of Personal Information - Disability - 98185E (10-10)
1 page - 62 kb
Authorization for the Collection and Communication of Personal Information - Death - 98185E01 (12-01)
1 page - 436 kb
Claim - Individual Insurance (Accidental Dismemberment or loss of sight, Fractures) - 03031A (11-03)
2 pages - 109 kb
Claim - Total Long-term Care - 06223E (12-03)
6 pages - 136 kb
Claimant's Statement - Death - Annuities - 98183 E (07-08)
1 page - 107 kb
Claimant's Statement - Death Claim - 98069E (09-08)
1 page - 57 kb
Critical Illness Claim form - 17025A (09-02)
2 pages - 66 kb
Critical Illness Claim form (Attending Physician's Statement) - 17026A (08-12)
2 pages - 123 kb
Claim for Health Care Benefits - SOLO Health (sold before October 25, 2010) - 1913211A (11-06) - Electronic form
2 pages - 208 kb
Claim for Health Care Benefits - SOLO Healthcare (sold as of October 25, 2010) - 1913216A (11-05) - Electronic form
2 pages - 212 kb
Direct Deposit Authorization (Life Claims) - 00368E (09-11)
1 page - 50 kb
Disability Claim - Employer or Self-Employed Individual's Statements -
0202452A (06-03)
1 page - 123 kb
Disability Claim - Individual - 0202451A (12-03)
2 pages - 54 kb
Disabled Person's Supplementary Statement Disability - 212101A (10-01)
1 page - 50 kb
Physical or Psychological Illnesses - Original Request - 020259A (09-12)
2 pages - 259 kb
Physical or Psychological Illnesses - Additional Report - 020269A (09-12)
2 pages - 209 kb
Proof of Death - Physician's Statement - 98083E (10-10)
1 page - 70 kb
RACQ - Physical or Psychological Illnesses - Original Request - 02025A (09-12)
2 pages - 208 kb
RACQ - Physical or Psychological Illnesses - Additional Report - 02026A (09-12)
2 pages - 256 kb
SOLO - Disability Claim - 09044E (09-05)
4 pages - 156 kb
SOLO - Additional Statement - 09045E (09-05)
1 page - 72 kb
SOLO - Business Expense Statement - 09110E (09-05)
1 page - 77 kb
SOLO - Detailed Statement of Overhead Expenses and Income Earned in the Case of Residual Disability - 09111E (09-05)
1 page - 80 kb
Group Insurance
All Provinces except Quebec
Claim - Group - Accidental Dismemberment of Loss of Sight / Fractures -
0280901A (09-10) - Electronic form
2 pages - 367 kb
Disability Claim - Employer and Employee Statements - 98124E01 (07-11)
2 pages - 345 kb
Death Claim - Life Claims - 0222701A (10-01)
2 pages - 566 kb
Quebec only
Application for Reimbursement - Business Expense Insurance - 02805A (07-02)
1 page - 50 kb
Claim - Group - Accidental Dismemberment of Loss of Sight / Fractures -
02809A (09-10) - Electronic Form
2 pages - 229 kb
Death Claim - Life Claims - 02227A (10-01)
2 pages - 566 kb
Disability Claim - Employer and Employee Statements - 98124E (07-11)
2 pages - 345 kb
Total disability benefits claim - Insured person's statement - 03011A (10-08) - Electronic form
2 pages - 213 kb