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

For New Customers

To apply for Term Life, Accidental Death & Dismemberment, or Dependent Children Term Life:

  1. If you would like your premiums deducted through payroll deduction determine whether your School District participates in the “Premium by Payroll Deduction" administration process by reviewing this School District List. If you would like more information on the premium administration process, refer to the “How will my premiums be collected” section of the Common Questions page of this website.

    If your School District is on this list, open and print Application for Voluntary Term Life and/or Accidental Death & Dismemberment Insurance form.
  2. If your School District is NOT on the list, if you are a Teacher on Call, if you are not actively at work, or if you simply prefer to pay premiums directly to our office open and print theApplication for Voluntary Term Life and/or Accidental Death & Dismemberment Insurance Individually Billed form.
  3. If you are applying for Dependent Children Term Life Insurance, please also complete the Supplemental Application for Dependent Child Insurance.

To apply for Critical Illness Insurance:

  1. Download the form:

Mail your completed application to Industrial Alliance:

Special Markets Solutions
Industrial Alliance Insurance and Financial Services Inc.
400 - 988 Broadway W
Po Box 5900
Vancouver BC, V6B 5H6


For Existing Customers

Need to make a change? Here are forms for common changes:

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)



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