Individual Life Insurance application for Policy Change

This service will generate a life policy change or term conversion/exchange application with a unique reference number appended to the bottom of the form.

**IMPORTANT**

In order to ensure proper tracking and reporting of your policy change or term conversion/exchange, 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.

Please note that this service will also generate the necessary parts of the Canada Life Individual Life insurance application for policy change for submitting the following application choices:

Entire Application (all pages 17-8217)
Life policy change not requiring underwriting (includes the investment option supplement, form 17-8139)
Life policy change requiring underwriting (includes the investment option supplement, form 17-8139)
Term conversion/exchange (includes the investment option supplement, form 17-8139)
Term conversion/exchange requiring underwriting (includes the investment option supplement, form 17-8139)
Exercising Guaranteed insurability rider (GIR) / Guaranteed increase option (GIO) / Policy purchase option (PPO) to increase an existing universal life policy (includes the investment option supplement, form 17-8139)