Application for life and adult critical illness insurance

This service will generate the following forms:

• a combined application for life and adult critical illness insurance with a unique reference number appended to the bottom of the form,

• a Product pages form, and

• a Supplement to the application for Millennium universal life insurance form.

**IMPORTANT**
In order to ensure proper tracking and reporting of your new business, please ensure that you print only one copy of the application. Do not photocopy a blank application for multiple submissions. If you would like to create more than one application, please click on the Refresh button of your browser to generate a new reference number or use your Back button to select another application (or another application type) and this will generate a new number.

Click here to choose the 2/09 version of the Application for life and adult critical insurance form including the Product pages, form 17-8300 – version 2-09 and investment option supplement, form 17-8139 – 6/09 version.

Separate forms

Product pages for the Application for life and adult critical illness insurance (17-8300)

Supplement to the application for Millennium universal life insurance – Interest option selection for allocation of funds (17-8139)

Important information

Important information on new Canada Life combined life and CI insurance application