Forms

For New Customers

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

1. Select from the following:
   • Application for Voluntary Group Insurance - For Term Life Insurance, Accidental Death & Dismemberment Insurance and Critical Illness 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
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.
   400 - 988 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
• Request for Non-Smoker Rates Form
• Pre-Authorized Debit Agreement