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Individual Insurance Forms

Individual Insurance Forms

If you have any questions about completing the form or need assistance, please contact your advisor.

If you no longer have their contact information, don’t hesitate to reach out to us—we will gladly provide it.If you do not have a financial security advisor, please reach out to us at 819-478-1315 or 1-800-567-0988. To send us documentation, consult our contact information at the bottom of this page or send it to our mailing address: P.O. Box 696, Drummondville, Quebec, J2B 6W9.

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Administrative Forms

Accumulated Dividends Request

EN-1018A (EQC026)

Authorization Form

EN-1038A

Authorization Letter Non-Resident

EN-1023A (EQC081)

Authorization to Release Information to the Physician

EN-1047A

Beneficiary Change

EN-1029A (EQC013)

Cancellation Request

EN-1016A (EQC076)

Cash Value Request

EN-1034A (EQC031)

Certified Copy of Resolutions of the Board of Directors

EN-1033A (EQC088)

Change - Designation of Contingent Beneficiary

EN-1103A (EQC075)

Change of Advisor Request

EN-1019A (EQC022)

Contract Change Form

EN-1037A (EQC035)

Contract Duplicate Request

En-1020A (EQC023)

Contract Loan Request

EN-1017A (EQC021)

Contract Owner Change

EN-1031A (EQC014)

Conversion - Exchange

EN-1048A (EQC090)

Designation - Change of Contingent Owner

EN-1032A (EQC079)

Fund Transfert Request - Additional Lump Sum Deposit

EN-8005A (EQC030)

Modification (name and address)

EN-1015A (EQC012)

Notice of Movable Hypothec without Delivery

EN-1036A (EQC036)

Policyholder(s) - Payor(s) Identity Verification

EN-1025A (EQC085)

Pre-Authorized Debit (PAD)

EN-1040A (EQC038)

Reduced Paid-Up Insurance Request

EN-1026A (EQC025)

Request for Extended Paid-up Insurance

EN-1035A (EQC078)

Request for policy summary

EN-1024A (EQC083)

Retrocession

EN-1057A (EQC069)

Claims

Attending Physician's Statement

EN-1076A (EQC027)

Claim Request

EN-1080A (EQC077) | Accident Insurance

Claim Request

EN-1077A (EQC028) | Accidental Fracture

Claimant Statement Death Claim (Simplified Version)

EN-1074A (EQC019) | Life Insurance Issued more than 10 years ago and valued at less than $200,000

Claimant's Statement

EN-1081A (EQC029) | Accidental dismemberment, accidental loss of sight or paralysis resulting from an accident

Claimant's Statement

EN-1078A (EQC070) | Critical Illness

Claimant's Statement in Case of Loss of Employment

EN-1082A (EQC073)

Claimants Statement Death Claim

EN-1073A (EQC020) | Life Insurance Issued less than 10 years ago or for a value of over $200,000

Confidential Medical Certificate

EN-1079A (EQC071)

Death Certificate

EN-1075A (EQC011)

Our other forms:

Group Insurance

Advisor Documentation

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