Ambassador Forms for Group Benefits Plan Administrators

The following forms are for Ambassador plans only. (Ambassador plans cover plan members on foreign assignment who work for Canadian employers outside of Canada or the U.S.)

These forms are for Plan Administrator use only. If you’re a group plan member looking for claim forms, go to the Group Plan Members > Forms page.

Note: Some of these forms can be completed onscreen, by clicking in the space provided for writing and typing in your information. After printing the completed form, you will need to add any required signatures and dates by hand before you submit the form.

These documents are in PDF format. To view and print them, you need Adobe Acrobat Reader Version 4.0 or higher, which you can download, at no cost, from the Adobe website.

Administration forms

• Ambassador Employee Application M5958
  Use this form to submit information required to enroll new plan members in Ambassador plans.
• Ambassador Statement of Health Declaration M5960
  Give this form to plan members to apply for group coverage under the Ambassador plan.

Ambassador claim forms

To find Ambassador claim forms, go to the Group Plan Members > Forms page.