- Fill out and sign the form
- Gather original supporting documents
- Send everything to the address indicated on the form
Accirance Claim form – 15161E01 (PDF, 186 KB) Opens in a new window.
Used to submit a claim for:
- Disability (students aged 17-24 only)
The insured is responsible for any fees related to this form.
Claim for benefits following an accident – 17003E (PDF, 453 KB) Opens in a new window.
For all claims regarding a fracture or rupture, a disability (students only), the loss of a limb, the loss of sight, death or other.
Important : The insured is responsible for any fees related to this form.
Death, dismemberment or loss of use
Please contact us at
1-877-886-5042 This link will launch your default phone software..