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.
- All Provinces except Quebec
- Quebec
All Provinces except Quebec
Accident Injury or Illness Questionnaire
1 page - 66 kb
Alcohol Consumption and/or Drug use Questionnaire - 03221E01 (05-11)
1 page - 47 kb
Anxiety, Emotional or Stress Disorder Questionnaire
1 page - 108 kb
Application Memorandum - 05167E (05-12)
1 page - 33 kb
Automobile Racing Questionnaire - 00402E03(03-12)
1 page - 39 kb
Aviation and Sports Flying Questionnaire - 1701701A (06-04)
1 page - 46 kb
Back Pain or Spine Impairment Questionnaire
1 page - 66 kb
Cardiovascular Recheck - 3793L (02-01)
1 page - 49 kb
Detailed Examination - 05079E (07-04) - to be completed with form 15369A
1 page - 68 kb
Diabetes Questionnaire - Life Insured - 2471L (02-01)
1 page - 48 kb
Diabetes Questionnaire - Attending Physician - 99320E (02-01)
2 pages - 43 kb
Digestive Questionnaire - 99316E (02-01)
1 page - 43 kb
Driving History Questionnaire - 610 (03-04)
1 page - 38 kb
Epilepsy Questionnaire - 03230E01 (05-12)
1 page - 38 kb
Foreign Language Declaration
Chinese
1 page - 82 kb
Farsi (Arab)
1 page - 731 kb
Italian
1 page - 47 kb
Polish
1 page - 49 kb
Punjabi-pun
1 page - 689 kb
Spanish
1 page - 48 kb
Tamil
1 page - 72 kb
Motor Racing Questionnaire - 00402E03 (03-12)
1 page - 39 kb
Pulmonary and Bronchial Diseases Questionnaire - 1700901A (04-02)
1 page - 32 kb
Pulmonary and Bronchial Diseases Additional Questionnaire - 17009A (03-11)
1 page - 48 kb
Parachuting/Sky Diving/Hand Gliding Questionnaire - 00402E01 (02-04)
1 page - 41 kb
Physical or Psychological Illnesses - Original Request - 020259A (04-01)
1 page - 63 kb
Scuba diving, Rock climbing and Mountaineering Questionnaire - 04010E01 (04-02)
1 page - 37 kb
Tobacco Use Questionnaire - 3105L (03-04)
1 page - 53 kb
Foreign Residence/Travel Questionnaire - 03261E (03-12)
1 page - 30 kb
Authorization to collect and disclose personal information to a third party -
17008A (04-03)
1 page - 25 kb
Business Financial Questionnaire (to be completed for all applications of $1,250,000 and over (including in-force insurance) life or critical illness) - 03053E01 (04-02)
1 page - 37 kb
Personal Financial Questionnaire (to be completed for all applications of $1,250,000 and over (including in-force insurance) life or critical illness) - 03052E (05-07)
1 page - 36 kb
Financial Supplement - 00211E (02-04)
1 page - 38 kb
Quebec
Alcohol Consumption and/or Drug use Questionnaire - 03221E (05-11)
1 page - 48 kb
Authorization for the disclosure of a driving record by the SAAQ (HOOPER) - 7330-2 (08-04)
1 page - 2.4 Mo
Authorization for the disclosure of a driving record by the SAAQ (KEYFACTS) - 5981A 75 (08-04)
1 page - 26 kb
Automobile Racing Questionnaire - 03231E (07-07)
1 page - 73 kb
Aviation and Sports Flying Questionnaire - 17017A (06-04)
1 page - 47 kb
Cardiovascular Recheck - 3793L (02-01)
1 page - 49 kb
Detailed Examination - 05079E (07-04) - to be completed with form 15369A
1 page - 68 kb
Epilepsy Questionnaire - 03230E (05-12)
1 page - 38 kb
Scuba diving, Rock climbing and Mountaineering Questionnaire - 04010E (04-02)
1 page - 38 kb
Foreign Residence/Travel Questionnaire - 03261E (03-12)
1 page - 30 kb
Foreign Language Declaration
Chinese
1 page - 82 kb
Farsi (Arab)
1 page - 731 kb
Italian
1 page - 47 kb
Polish
1 page - 49 kb
Punjabi-pun
1 page - 689 kb
Spanish
1 page - 48 kb
Tamil
1 page - 72 kb
Authorization to collect and disclose personal information to a third party -
17008A (04-03)
1 page - 25 kb
Business Financial Questionnaire (to be completed for all applications of $1,250,000 and over (including in-force insurance) life or critical illness) - 03053E (05-07)
1 page - 37 kb
Personal Financial Questionnaire (to be completed for all applications of $1,250,000 and over (including in-force insurance) life or critical illness) - 03052E (05-07)
1 page - 36 kb
Financial Supplement - 00211E (02-04)
1 page - 38 kb
Disability Benefit Questionnaire - 05053E (06-05)
1 page - 38 ko