Please note you will need Adobe Acrobat Reader, available free from Adobe, to view and print forms.
For New Customers
Want to apply for a plan? Here's how:
- Select from the following:
- Application for Voluntary Group Insurance- For Term Life Insurance, Accidental Death & Dismemberment Insurance, Critical Illness Insurance, Long Term Disability, and Office Overhead Insurance.
- If you are applying for Dependent Children Term Life or Critical Illness Insurance, please also complete the Supplemental Questionnaire for Dependent Child Insurance.
- Application for Extended Health & Dental Insurance
- Complete the application in full.
- 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
For Existing Customers
Need to make a change to your plan? Here are forms for common plan changes:
- Beneficiary Designation Form
- Name and Address Change Form
- Pre-Authorized Credit Card Payment Plan Request Form
- Request for Non-Smoker Rates Form
- Pre-Authorized Debit Agreement
Can't find what you're looking for? We're here to help.
Our Client Service Specialists can help you with any questions you may have. (Office hours: 6:30am to 4:30pm Pacific Time)
1 (800) 266-5667