Broker Forms

All English forms are available in fillable PDF format. You can also print them as well.

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Choose a section:

• Change/Reinstatement/Conversion Applications
• Underwriting Supplemental Forms
• Annuity Applications
• Customer Service Forms
• Claim Forms - Life Policies
• Claim Forms - Critical Illness Policies
  
  

Change/Reinstatement/Conversion Applications

• Change/Reinstatement/Conversion Application  (07/2022)
• Change/Reinstatement/Conversion Application  (for policies issued prior to January 4, 2022)
• Application for Change (Non-Medical)  (07/2022)
• Application for Change (Non-Medical)  (for policies issued prior to January 4, 2022)
• Quick Reinstatement Application  (01/2022)
• Amendment to Life Application or Change/Reinstatement Application  (03/2014)

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Underwriting Supplemental Forms

• Voluntary Consent Form - Favourable Genetic Testing (10/2022)
• Alcohol Usage Questionnaire (04/2020)
• Arthritis Questionnaire  (04/2020)
• Attention Deficit Disorder Questionnaire  (04/2020)
• Aviation Questionnaire  (04/2020)
• Back Pain Questionnaire  (04/2020)
• Backcountry Snowmobiling Questionnaire  (04/2020)
• Blood Pressure Questionnaire  (04/2020)
• Blood Pressure Recheck  (04/2020)
• Bronchitis or Asthma Questionnaire  (04/2020)
• Cancer Questionnaire  (04/2020)
• Chest Pain Questionnaire  (04/2020)
• Diabetic Questionnaire - Applicant  (04/2020)
• Drug Usage Questionnaire  (04/2020)
• Financial Questionnaire  (04/2020)
• Foreign Residence and Travel Questionnaire  (04/2020)
• Gastrointestinal Disorder Questionnaire  (04/2020)
• Heart Murmur Questionnaire  (04/2020)
• Hypertension Questionnaire  (04/2020)
• Motor Sports Racing Questionnaire  (11/2020)
• Mountaineering Questionnaire  (04/2020)
• Nervous Disorder Questionnaire  (04/2020)
• Scuba Diving Questionnaire  (04/2020)
• Seizure Questionnaire  (04/2020)
• Skydiving or Parachuting Questionnaire  (04/2020)
• Tobacco Usage Questionnaire  (04/2020)

Annuity Applications

• Guaranteed Investment Annuity (Non-Registered) Application  (11/2022)
• Guaranteed Retirement Annuity (RSP) Application  (11/2022)
• Individual Savings Plan Allocation of Contributions  (11/2022)
• Retirement Income Fund (RIF) Application  (11/2022)
• Single Premium Immediate Annuity Application  (12/2021)
• Registered Investment Transfer Form  (11/2022)
• Non-Registered Investment Transfer Form  (11/2022)

Customer Service Forms

• Address Change  (11/2022)
• Annuity Withdrawal Form  (12/2021)
• Agent of Record/Servicing Agent Change  (05/2020)
• Banking Change / Pre-Authorized Debit Application  (10/2022)
• Beneficiary Change  (11/2022)
• Collateral Assignment of Policy  (05/2020)
• Contingent Policy Owner Form   (05/2020)
• Direct Deposit Enrollment Form  (05/2020)
• Dividend Change  (05/2020)
• Name Change  (11/2022)
• Policy Loan Application  (11/2022)
• Policy Termination Request  (05/2020)
• Pre-Authorized Debit Agreement Cancellation Request  (01/2022)
• Letter of Authorization for Non-Residents  (05/2020)
• Request for Duplicate Policy  (05/2020)
• Release of Assignment  (05/2020)
• Transfer of Ownership  (11/2022)
• Declaration of Tax Residence for Individuals  (2022)
• Declaration of Tax Residence for Entities  (2022)
• Universal Life Withdrawal Form  (05/2020)
• Life Insurance Replacement Declaration  (08/2019)

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Claim Forms - Life Policies

• To be completed by Claimant:
• Continuing Disability - Claimant's Statement  (07/2020)
• Death Claim - Claimant's Statement  (07/2020)
• Waiver of Premium Benefit - Claimant's Statement  (07/2020)
• To be completed by Physician:
• Continuing Disability - Attending Physician's Statement  (07/2020)
• Death Claim - Physician's Statement  (07/2020)
• Initial LTD Benefit - Attending Physician's Statement  (07/2020)

 Claim Forms - Critical Illness Policies

• • To be completed by Claimant:
    • All Illnesses - Claimant's Statement  (06/2020)
  • To be completed by Physician: If the Insured’s Critical Illness is not listed here, please use the Attending Physician Statement  - General Form.

• • • Attending Physician Statement  - General  (06/2022)
    • Alzheimer's Disease - Physician's Statement  (06/2020)
    • Benign Brain Tumor - Physician's Statement   (06/2020)
    • Blindness - Physician's Statement  (06/2020)
    • Cancer - Physician's Statement  (06/2020)
    • Coronary Artery Bypass - Physician's Statement  (06/2020)
    • Deafness - Physician's Statement  (06/2020)
    • Heart Attack - Physician's Statement  (06/2020)
    • Kidney Failure - Physician's Statement  (06/2020)
    • Multiple Sclerosis - Physician's Statement  (06/2020)
    • Organ Transplant - Physician's Statement  (06/2020)
    • Paralysis - Physician's Statement  (06/2020)
    • Parkinson's Disease - Physician's Statement  (06/2020)
    • Stroke - Physician's Statement  (06/2020)

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