Critical illness insurance

Important: before you begin

  1. Please call us prior to sending one of the following forms. Other documents may be required.

  2. Print, fill out and sign the form.
  3. Gather original supporting documents.
  4. Send everything to the address indicated on the form.

Critical illness insurance forms


Critical Illness claim form - Insured's statement – 17025A (PDF, 207 KB) Opens in a new window.

Important:

Your claim must include Form 17026A, duly completed by both the claimant and the attending physician.


Critical Illness claim form - Cancer, heart attack, stroke or other illness - Attending physician's statement – 17026A (PDF, 114 KB) Opens in a new window.

Important:

Must be completed by both the claimant and the attending physician. The claimant is responsible for paying any fees that may be charged for filling out the form.


Insurability question number 2 on pre-existing conditions - 07043E (PDF, 79 KB) Opens in a new window.

Reference table to help to fill the Insurability Question Number 2 on pre-existent Conditions.