Representative’s Resource Library
Forms
Administration
Claims
Underwriting
Administration
- Authorization to collect personal information (PDF – 212 Kb)
- Cancellation Request (PDF – 190 Kb)
- Change of occupation (PDF – 112 Kb)
- Declaration of health(PDF – 739 Kb)
- Declaration of health short form – Reinstatement(PDF – 58 Kb)
- Declaration of health - Accident Only (Superior Program)(PDF – 161 Kb)
- Income sharing (PDF – 130 Kb)
- Legal change request(PDF – 71 Kb)
- Modification to the effective date of contract - Acci-Jet Program(PDF – 23 Kb)
- Needs analysis(PDF – 61 Kb)
- Overhead Expense Insurance(PDF – 51 Kb)
- Overhead Expense Insurance for Farm Enterprises(PDF – 50 Kb)
- Overhead Expense Insurance for Truck Owners(PDF – 50 Kb)
- Pre-authorized Debit Agreement (PDF – 253 Kb)
- Reinstatement form Acci-Jet (PDF – 193 Kb)
- Reinstatement form Cancer Guard (PDF – 193 Kb)
- Reinstatement form Excel Hospitalization (PDF – 49 Kb)
- Reinstatement form Excel Life (PDF – 50 Kb)
- Trucker - Driver - Transport driver(PDF – 54 Kb)
Declaration of Understanding
- Declaration Arabic (PDF - 241 Kb)
- Declaration Filipino (PDF – 108 Kb)
- Declaration German (PDF - 112 Kb)
- Declaration Greek (PDF - 108 Kb)
- Delcaration Haitian Creole (PDF - 303 Kb)
- Declaration Hindi (PDF - 280 Kb)
- Declaration Italian (PDF – 110 Kb)
- Declaration Japanese (PDF – 345 Kb)
- Declaration Korean (PDF - 373 Kb)
- Declaration Mandarin simplified (PDF – 305 Kb)
- Declaration Mandarin traditional (PDF – 176 Kb)
- Declaration Polish (PDF – 109 Kb)
- Declaration Portuguese (PDF – 108 Kb)
- Declaration Punjabi (PDF – 384 Kb)
- Declaration Russian (PDF – 111 Kb)
- Declaration Sinhalese (PDF - 178 Kb)
- Declaration Spanish (PDF – 107 Kb)
- Declaration Tamil (PDF - 134 Kb)
- Declaration Thaï (PDF – 154 Kb)
- Declaration Turkish (PDF - 110 Kb)
- Declaration Vietnamese (PDF – 181 Kb)
Claims
- Procedures for filing a claim (PDF – 40 Kb)
Individual Insurance
Accident Health Insurance
- Accident Health Insurance Benefit (PDF – 23 Kb)
Acci7
- Claim form for Acci7 (PDF – 41 Kb)
- Claim form for Acci7 (Resident, other than Province of Quebec) (PDF – 41 Kb)
Acci-Jet Program
- Application for return of premium (PDF - 98 Kb)
- Authorization (PDF – 42 Kb)
- Determining the amount of the monthly benefit (PDF – 140 Kb)
- Eligibility rules for home-based workers (PDF - 1,2 MB)
- Occupational Classes (PDF - 506 Kb)
- Overhead Expenses Claim Form (PDF – 55 Kb)
- Statement by Attending Physician (PDF – 126 Kb)
- Statement of Attending Physician - Psychological Illnesses (PDF – 193 Kb)
- Statement of Claimant(PDF – 68 Kb)
- Statement of Claimant (Resident, other than Province of Quebec) (PDF – 68 Kb)
- Statement of Income and job description (PDF – 28 Kb)
- Statement of Return to Work (PDF – 133 Kb)
Accxel (in force only)
- Accidental Dismemberment and Loss of Signs (PDF – 206 Kb)
- Application for return of premium (PDF - 98 Kb)
- Authorization RAMQ (PDF – 52 Kb)
- Hospitalization Insurance Claim Form (PDF – 871 Kb)
- Attending Physician's Statement (PDF 87 Kb)
- Hospitalization Insurance Claim Form (Resident, other than Province of Quebec) (PDF – 871 Kb)
- Individual Insurance Claim & Proof of Death (PDF – 55.2 Kb)
- Monthly Benefit Declaration of Disability (Resident, other than Province of Quebec) (PDF – 580 Kb)
- Overhead Expenses Claim Form (PDF – 55 Kb)
- Statement of Return to Work (PDF – 133 Kb)
Cancer Guard
- Application for return of premium (PDF - 98 Kb)
- Statement of Claimant and Attending Physician (PDF – 162 Kb)
Hospitalization Insurance
- Application for return of premium (PDF - 98 Kb)
- Claim form accident health insurance benefit (PDF – 29 Kb)
- Hospitalization Insurance Claim Form (PDF – 871 Kb)
- Attending Physician's Statement (PDF 87 Kb)
Life Insurance
- Authorization RAMQ (PDF – 59 Kb)
- Authorization to collect information (PDF – 48 Kb)
- Individual Insurance Claim & Proof of Death (PDF – 55 Kb)
Superior Program
- Application for return of premium (PDF - 98 Kb)
- Authorization (PDF – 42 Kb)
- Authorization RAMQ (PDF – 52 Kb)
- Determining the amount of the monthly benefit (PDF – 140 Kb)
- Eligibility rules for home-based workers (PDF - 1,2 MB)
- Occupational Classes (PDF - 506 Kb)
- Overhead Expenses Claim Form (PDF – 55 Kb)
- Overhead Expenses Claim Form - Eligible Vehicule Expenses (PDF – 55 Kb)
- Statement of Attending Physician (PDF – 83 Kb)
- Statement of Attending Physician - Psychological Illnesses (PDF – 193 Kb)
- Statement of Claimant (PDF – 68 Kb)
- Statement of Claimant (Resident, other than Province of Quebec) (PDF – 68 Kb)
- Statement of Income and job description (PDF – 28 Kb)
- Statement of Return to Work (PDF – 133 Kb)
Travel Insurance
- Hospital and Medical Expenses – Quebec Residents (PDF - 106 Kb)
- Trip Cancellation(PDF – 100 Kb)
Universal Loan Insurance
- Application for return of premium (PDF - 98 Kb)
- Authorization (PDF – 42 Kb)
- Authorization RAMQ (PDF – 52 Kb)
- Eligibility rules for home-based workers (PDF - 1,2 MB)
- Form for Determining Benefit Amount (Including Rent) (PDF – 93 Kb)
- Form for Determining Benefit Amount (PDF – 92 Kb)
- Occupational Classes (PDF - 506 Kb)
- Statement to be made by Employer or by Insured if self-employed (PDF – 52 Kb)
- Statement to be made by Employer or by Insured if self-employed (Resident, other than Province of Quebec) (PDF – 100Kb)
- Statement of Attending Physician (PDF – 83 Kb)
- Statement of Attending Physician - Psychological Illnesses (PDF – 193 Kb)
- Statement of Claimant (PDF – 80 Kb)
- Statement of Claimant (Resident, other than Province of Quebec) (PDF – 80 Kb)
- Statement of Return to Work (PDF – 133 Kb)
MRA groups
- Accidental dismemberment and loss of signs (PDF – 214 Kb)
- Authorization (PDF – 104 Kb)
- Authorization for disclosure of information (PDF – 72 Kb)
- Death authorization (PDF – 319 Kb)
- Dependent's life insurance benefit claim and proof of death (PDF – 104 Kb)
- Life insurance benefit claim and proof of death (PDF – 108 Kb)
- Long-term disability insurance claim or request for waiver of premiums (PDF – 146 Kb)
- Overhead Expenses Claim Form (PDF – 55 Kb)
- Overhead Expenses Claim Form - Eligible Vehicule Expenses (PDF – 55 Kb)
- Statement to be made by employer or by Insured if self-employed (PDF – 96 Kb)
- Statement to be made by Employer or by Insured if self-employed (Resident, other than Province of Quebec) (PDF – 100Kb)
- Statement to be made by attending physician (PDF – 161 Kb)
- Statement of Attending Physician - Psychological Illnesses (PDF – 193 Kb)
- Statement of income and job description ($1,000 and -) (PDF – 96 Kb)
- Statement of income and job description ($1,000 and +) (PDF – 98 Kb)
Underwriting
- Authorization (PDF – 52 Kb)
- Aviation or Aerial Sports (PDF – 60 Kb)
- Back (PDF – 58 Kb)
- Bowel disorders (PDF – 57 Kb)
- Cardiovascular disorders (PDF – 57 Kb)
- Climbing or mountaineering (PDF – 56 Kb)
- Diabetes (PDF – 59 Kb)
- Digestive disorders (PDF – 58 Kb)
- Driving record (PDF – 57 Kb)
- Drug use (PDF – 56 Kb)
- Epilepsy (PDF – 57 Kb)
- Joints (PDF – 57 Kb)
- Motor sports (PDF – 56 Kb)
- Nervous disorders (PDF – 57 Kb)
- Out-of-country travel or stays (PDF – 57Kb)
- Preparing for your phone interview or paramedical exam (PDF - 104 Kb)
- Pulmonary disorders (PDF – 59 Kb)
- Request to change Smoker rate to Non-Smoker rate (PDF - 61 Kb)
- Request to change Smoker rate to Non-Smoker rate - Acces Life (PDF - 440 Kb)
- Request to change Smoker rate to Non-Smoker rate - CancerGuard (PDF - 166 Kb)
- Rider (PDF – 53 Kb)
- Trucker driver - Transport driver (PDF – 54 Kb)
- Underwater diving (PDF – 58 Kb)
- Urinary disorders (PDF – 58 Kb)