Important: before you begin
Please call us prior to sending one of the following forms. Other documents may be required.
- Print, fill out and sign the form.
- Gather original supporting documents.
- Send everything to the address indicated on the form.
Vision and SOLO product forms
Claimant's statement - Death claim – 98069E (PDF, 334 KB) Opens in a new window.
To be completed to notice us of death.
Death certificate must be attached to the completed form.
Request for change of policyowner – 09614A (PDF, 1.1 MB) Opens in a new window.
Form to be completed if you wish to:
- change the policyowner or add a second policyowner
- designate or change the beneficiary for: life, long term care, critical illness and health coverage insurance
- designate or change the trustee for minor beneficiary
- designate or change the contingent policyowner
- designate or change the contingent beneficiary
- change name for individuals and legal entity
- change the policyowner following the death of the current policyowner.
Total Long-term Care (Independent Living, Loss-of-independence Coverage, Long-term Care Advance, Accelerated Independence) – 06223E (PDF, 310 KB) Opens in a new window.
To submit a claim in the case of a loss-of-independence.
Changes to the savings fund of a Vision contract – 06252E (PDF, 181 KB) Opens in a new window.
To be completed to make a change to the Savings funds of a Vision Contract.
Authorization to collect and communicate personal information (Death) - 06024E (PDF, 286 KB) Opens in a new window.
Must be completed when submitting a claim in the event of death.
Original document required.