Apply Now

Our online applications are the fastest, easiest way to apply for coverage. You can get a quote in minutes, with no obligation to apply.

To apply for:
  • Term Life Insurance
  • Critical Illness Insurance
  • Accidental Death & Dismemberment Insurance

To use Industrial Alliance's online application, you must have JavaScript and Cookies enabled on your browser. You will also need Adobe Acrobat reader, available free from Adobe, to view and print the application form.
Please note if you do not have existing coverage under this policy you will need to provide credit card information if you wish to submit your application electronically.

Print an Application

Want to apply for a plan? Here's how:

  1. Select from the following:
  2. Complete the application in full.
  3. Mail your completed application along with a cheque for your first month's premium, if applicable, to Industrial Alliance at the following address:

    Special Markets Solutions
    Industrial Alliance Insurance and Financial Services Inc.
    2165 Broadway W.
    PO Box 5900
    Vancouver BC, V6B 5H6

Please note you will need Adobe Acrobat Reader, available free from Adobe, to view and print the application form.

Request an Application

To request an application: Email Industrial Alliance at or call 1 (800) 266-5667 for any of the above products.

Questions? We're here to help.
Call 1 (800) 266-5667 or email