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Life insurance

Life insurance

Easy access to forms and information to support your life insurance business with Canada Life

Service request forms (e.g., address change or inforce illustration requests) are also available to the right.

The content of each form is protected for legal purposes and cannot be altered.

 
Claims
Client service
New business
Underwriting
 
Claims Back to Top
17-8226 CAN Proof of Death - Physician Statement
[ PDF; Jul. 20, 2006; 145KB; 17-8226 CAN ]
17-8242 - Claimant statement form
[ PDF; Jul. 18, 2008; 130KB ]
B6809B-2 - Physical demands worksheet
[ PDF; Jul. 19, 2006; 258KB ]
Life insurance waiver of premium claim form
[ PDF; Nov. 06, 2008; 235KB ]
 
Client service Back to Top
109C CAN Universal Life Financial Change Application
[ PDF; Jan. 21, 2007; 173KB; 109C CAN ]
1550 CAN Loan Request
[ PDF; Jul. 20, 2006; 105KB; 1550 CAN ]
17-8139 Millennium UL Supplementary App (use with 405 and 17-8217)
[ PDF; Jun. 17, 2009; 188KB ]
17-8165 Millennium UL Financial Transaction Application (for policies issued Sep
[ PDF; Jun. 17, 2009; 257KB; 17-8165 ]
17-8191 Notice of hypothecation - Notice of release of hypothecation
[ PDF; Feb. 26, 2007; 152KB; 17-8191 ]
17-8247 - Term conversions and policy change - Transmittal form
[ PDF; Jul. 20, 2006; 161KB ]
17-8278 Additional deposit option (ADO) request
[ PDF; May 20, 2008; 117KB; 17-8278 ]
17-8294 - Politically exposed foreign person determination (PEFP)
[ PDF; Jun. 16, 2008; 25KB; 17-8294 ]
17-8296 - Certification of personal identity
[ PDF; Nov. 03, 2009; 17KB; 17-8296 ]
17-8333 Confirmation of account
[ PDF; Aug. 10, 2010; 83KB; 17-8333 ]
320 CAN Pac Plan Authorization
[ PDF; Feb. 11, 2010; 193KB; 320 ]
332 CAN Surrender Request Form
[ PDF; Dec. 15, 2008; 34KB; 332 ]
364 Declaration of Loss of Policy
[ PDF; Jul. 20, 2006; 34KB; 364 ]
5015 CAN Authorization to Release Information
[ PDF; Mar. 07, 2007; 57KB ]
50C BIL New Interest Options - Target Life - Supplementary Application
[ PDF; Jul. 25, 2006; 125KB; 50C BIL ]
584 CAN Title Change Beneficiary Change Form
[ PDF; Mar. 07, 2007; 129KB; 584 CAN ]
66 CAN Assignment Form
[ PDF; Mar. 07, 2007; 78KB; 66 CAN ]
740 CAN Dividend Option and Premium Offset Election
[ PDF; Mar. 15, 2007; 112KB; 740 CAN ]
Application for life policy change (entire application) - 17-8217
[ HTML; Jul. 01, 2009; 17-8217 ]
B2518A-5 Application for Partial Withdrawal
[ PDF; Mar. 15, 2007; 89KB ]
 
New business Back to Top
17-8133 Amendment to insurance application (for non-resident applicant)
[ PDF; Jun. 26, 2009; 125KB; 17-8133 ]
17-8139 Millennium UL Supplementary App (use with 405 and 17-8217)
[ PDF; Jun. 17, 2009; 188KB ]
17-8190 Life checklist
[ PDF; Jul. 24, 2007; 162KB; 17-8190 ]
17-8282 Simply Preferred term life insurance product page
[ PDF; Aug. 18, 2008; 36KB; 17-8282 ]
17-8283 Participating life insurance product page
[ PDF; Aug. 18, 2008; 44KB; 17-8283 ]
17-8284 Millennium universal life insurance product page
[ PDF; Mar. 10, 2010; 914KB; 17-8284 ]
17-8299 - Application for life and adult critical illness insurance
[ HTML; Jun. 17, 2009; 17-8299 ]
17-8300 Product pages for the Application for life and adult CI insurance
[ PDF; Mar. 10, 2010; 240KB; 17-8300 ]
320 CAN Pac Plan Authorization
[ PDF; Feb. 11, 2010; 193KB; 320 ]
332 CAN Surrender Request Form
[ PDF; Mar. 25, 2008; 34KB; 332 ]
66 CAN Assignment Form
[ PDF; Mar. 07, 2007; 78KB; 66 CAN ]
Application for individual life insurance - 405
[ HTML; Mar. 10, 2010 ]
E5112A-3 Declaration Of Continued Insurability
[ PDF; Feb. 10, 2009; 26KB ]
Telephone application for individual life insurance - 413
[ HTML; Jul. 20, 2009 ]
 
Underwriting Back to Top
17-8238 Driving questionnaire
[ PDF; Jul. 19, 2006; 76KB ]
17-8304 Musculoskeletal questionnaire
[ PDF; Feb. 12, 2010; 64KB; 17-8304 ]
17-8305 Arthritis questionnaire
[ PDF; Feb. 12, 2010; 69KB; 17-8305 ]
17-8306 Sleep disorder questionnaire
[ PDF; Feb. 12, 2010; 49KB; 17-8306 ]
17-8327 - Thyroid questionnaire
[ PDF; Aug. 19, 2010; 153KB; 17-8327 ]
B0078J-1 Military Aviation Questionnaire
[ PDF; Jul. 19, 2006; 64KB ]
B0274H-1 Blood Pressure Questionnaire
[ PDF; Jul. 19, 2006; 66KB ]
B0274M-1 Diabetes Questionnaire
[ PDF; Jul. 19, 2006; 104KB ]
B0275A-1 Activities Of Daily Living Questionnaire
[ PDF; Jul. 19, 2006; 104KB ]
B0418B-1 Chest Pain Questionnaire
[ PDF; Jul. 19, 2006; 101KB ]
B0422B-1 Tumour Questionnaire
[ PDF; Jul. 19, 2006; 82KB ]
B0425A-4 Nicotine Use Questionnaire
[ PDF; Jul. 19, 2006; 104KB; B0425A-4 ]
B0426A-1 Drug Questionnaire
[ PDF; Jul. 19, 2006; 108KB ]
B0427C-2 - Nervous Disorder Questionnaire
[ PDF; Jul. 19, 2006; 77KB ]
B0430B-2 Alcohol Questionnaire
[ PDF; Jul. 19, 2006; 89KB ]
B0431A-2 Racing Questionnaire
[ PDF; Jul. 19, 2006; 66KB ]
B0433A-2 Seizure Questionnaire
[ PDF; Jul. 19, 2006; 78KB ]
B0434B-2 Diabetic Questionnaire - Health Care Practitioner
[ PDF; Jul. 19, 2006; 90KB ]
B0435A-3 Climbing Questionnaire
[ PDF; Jul. 19, 2006; 67KB ]
B0436A-2 Gastrointestinal Questionnaire
[ PDF; Jul. 19, 2006; 84KB ]
Service request forms    
Address change
Bank information change
Inforce illustrations-par request
Inforce illustrations-universal life request
Other inquiries
Contacts    
Life insurance contacts
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