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:

  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.
    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:

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


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