Broker Forms



Broker Forms

All English forms are available in fillable pdf format.

For detailed steps on how to use the fillable pdf forms, see the following instructions.

Please note: If you are opening one of these fillable pdf format files with Firefox, you may receive a warning stating "This PDF document might not be displayed correctly." If this occurs, select the option "Open With Different Viewer" provided in the upper right hand corner of your screen. A pop-up box will appear asking you "What should Firefox do with this file?" select the "Open with" option and click ok

Choose a section:

Life Applications

    • Encrypted Full Life or Quick Life Applications (designed to be completed and submitted electronically)
    • Encrypted Instant Issue or Quick Issue CI Applications (designed to be completed and submitted electronically)

      Step 1: Open the applicable Encrypted Application (Full, Quick, Instant Issue, or Quick Issue CI). The password is "broker".
      Step 2: Save a copy of the Encrypted Application to your computer, and reopen the file using adobe reader (to avoid potential issues please avoid completing the application while in the internet browser).
      Step 3: Complete the application with your client.
      Step 4: Click the "Complete Application" button (located on first or last page). This will lock the form from any further changes and will open a Save As window. Save the file.
      Step 5: Once saved, a 13 digit application number will appear on the first and last page as well as in the footer on every page. This application number will be required on the applicable Encrypted Declarations & Authorizations Signature Form. The completed application should be sent to your client for them to review.
      Step 6: Complete the applicable Encrypted Declarations & Authorizations Signature Form (see printable copy above or hard copies are available from Executive Office).
      Step 7: Email/fax the Encrypted Application and the Encrypted & Declarations Authorizations Signature Form.
      Completed Encrypted Applications should be sent to ElectronicApplications@wawanesa.com or faxed
      to 1-888-924-0797.

    Change/Reinstatement/Conversion Applications

    Note: For reinstatement of a Quick Issue Critical Illness or Instant Issue Plan, please use the Quick Issue Critical Illness Application or Instant Issue Plan Application, respectively (see above section).

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    Underwriting Supplemental Forms


    Annuity Applications


    Customer Service Forms

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    Claim Forms - Life Policies


     Claim Forms - Critical Illness Policies

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