General forms
Important : These three forms need to be transmitted at the same time.
Disability claim – Disabled person’s statement – 17001E (PDF, 869 KB) Opens in a new window.
To be completed when submitting a claim for disability benefits.
Attending physician’s statement – Original request – 020255A (PDF, 145 KB) Opens in a new window.
Must be filled in by the claimant’s personal physician to describe the claimant’s current health status.
Important : The insured is responsible for any fees related to this form.
Authorization to collect and communicate personal information (disability) – 98185E (PDF, 285 KB) Opens in a new window.
Must be completed when submitting a disability claim.
Important : Original document required.
Attending physician’s statement – Additional report – 020265A (PDF, 237 KB) Opens in a new window.
Must be filled in by the claimant’s personal physician to describe the claimant’s current health status.
Important : The insured is responsible for any fees related to this form.
Information about eligible loans for SOLO Loan Insurance benefits – 17013E (PDF, 261 KB) Opens in a new window.
To submit a claim for SOLO Loan Insurance disability benefits (description of all eligible loans).
Specific forms
Specific form
Loss of employment coverage
Claim for loss of employment benefits – 17004E (PDF, 770 KB) Opens in a new window.
To submit a claim for disability benefits in the event of job loss.
Important : Must be completed by the claimant and the employer.
Residual or Partial Disability coverage
Additional statement regarding a disability – Employer or self-employed individual’s statement – 17011E (PDF, 809 KB) Opens in a new window.
To be completed when submitting a claim for partial disability benefits.
Important : Contract must include partial disability.
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Note
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