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 (03-07)
1 page - 33 kb
Claim - Convalescent Care - 98130E01 (07-01) - Electronic Form
2 pages - 152 kb
Claim Form for Dental Care Expenses - 1911001A (07-03) - Electronic Form
2 pages - 153 kb
Claim - Individual Insurance (Accidental Dismemberment or loss of sight, Fractures) - 0303101A (05-11)
2 pages - 53 kb
Claim - Total Long-term Care - 06223E (06-12)
6 pages - 98 kb
Claimant's Statement - Death - Annuities - 98183 E (07-02)
1 page - 107 kb
Claimant's Statement - Death Claim - 98069E01 (07-02)
1 page - 84 kb
Claim Statement - Long Term Care Insurance - 06027E (06-02)
2 pages - 127 ko
Critical Illness Claim form - 1702501A (05-11)
2 pages - 48 kb
Critical Illness Claim form (Attending Physician's Statement) - 1702601A (05-11)
4 pages - 120 kb
Claim Form for Health Care Benefits - 1913201A (07-12) - Electronic Form
2 pages - 250 kb
Declaration of dependant children aged 18 to 25 or 21 to 25 who are full-time
students - 1913101A (05-06)
1 page - 31 kb
Direct Deposit Authorization - 0719E01 (07-11)
1 page - 49 kb
Disability Claim - Employer or Self-Employed Individual's Statements -
0202452A (06-03)
1 page - 123 kb
Disability Claim - Individual - 0202451A (08-04)
2 pages - 75 kb
Long Term Care Insurance - Physician Statement - 06026E (06-02)
2 pages - 145 kb
Proof of Death - Physician's Statement - 98083E01 (05-01)
1 page - 32 kb
Total Disability Benefits Claim - Insured Person's Statement - 0301101A (04-07)
2 pages - 40 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 (02-06)
1 page - 36 kb
Authorization for the Collection and Communication of Personal Information - Death - 98185E01 (03-08)
1 page - 31 kb
Claim - Convalescent Care - 98130E (07-01) - Electronic Form
2 pages - 150 kb
Claim Form for Dental Care Expenses - 19110A (07-03) - Electronic Form
2 pages - 153 kb
Claim - Individual Insurance (Accidental Dismemberment or loss of sight, Fractures) - 03031A (07-1)
2 pages - 99 kb
Claim - Total Long-term Care - 06223E (06-12)
6 pages - 98 kb
Claimant's Statement - Death - Annuities - 98183 E (07-02)
1 page - 107 kb
Claimant's Statement - Death Claim - 98069E (07-02)
1 page - 84 kb
Critical Illness Claim form - 17025A (05-11)
2 pages - 53 kb
Critical Illness Claim form (Attending Physician's Statement) - 17026A (05-11)
4 pages - 123 kb
Claim Form for Health Care Benefits - 19132A (07-12) - Electronic Form
2 pages - 247 kb
Declaration of dependant children aged 18 to 25 or 21 to 25 who are full-time
students - 19131A (04-12)
1 page - 30 kb
Direct Deposit Authorization (Life Claims) - 00368E (05-11)
1 page - 27 kb
Direct Deposit Authorization (Health Claims) - 07019E (07-11)
1 page - 48 kb
Disability Claim - Employer or Self-Employed Individual's Statements -
0202452A (06-03)
1 page - 123 kb
Disability Claim - Individual - 0202451A (08-04)
2 pages - 75 kb
Disabled Person's Supplementary Statement Disability - 2121A (04-05)
1 page - 50 kb
Physical Illness - Original Request - 020255A (05-11)
2 pages - 67 kb
Physical Illness - Additional Report - 020265A (05-11)
2 pages - 67 kb
Proof of Death - Physician's Statement - 98083E (05-01)
1 page - 33 kb
Group Insurance
All Provinces except Quebec
Claim Form for Health Care Benefits - 1913201A (07-12) - Electronic Form
2 pages - 250 kb
Claim for Dental Care Expenses - 1911001A (07-03) - Electronic Form
2 pages - 153 kb
Claim - Group - Accidental Dismemberment of Loss of Sight / Fractures -
0280901A (06-03) - Electronic form
2 pages - 382 kb
Disability Claim - Employer and Employee Statements - 98124E01 (07-11)
2 pages - 345 kb
Death Claim - Life Claims - 0222701A (05-02)
2 pages - 32 kb
Quebec only
Application for Reimbursement - Business Expense Insurance - 02805A (07-02)
1 page - 50 kb
Claim for Health Care Benefits - 19132A (07-12) - Electronic Form
2 pages - 247 kb
Claim Form for Dental Care Expenses - 19110A (07-03) - Electronic Form
2 pages - 153 kb
Claim - Group - Accidental Dismemberment of Loss of Sight / Fractures -
02809A (08-06)
2 pages - 380 kb
Death Claim - Life Claims - 02227A (08-06)
2 pages - 453 kb
Direct Deposit Authorization - Health Claims - 07019E (07-11)
1 page - 48 kb
Disability Claim - Employer and Employee Statements - 98124E (07-11)