Application and Evidence Forms

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.

• Evidence of Insurability Forms

• Evidence Form M5995(CI) – for Critical Illness (for all plans)
• Evidence Form M6129 – for all other benefits (for Selectpac plans with 3 to 35 plan members)
• Evidence Form M5995 – for all other benefits (for group plans with more than 35 plan members)
• Evidence Form M5995(CHOLIFE) – for all other benefits (for group plans which include Child Optional Life)

• Application for Optional Group AD&D M6708
• Application for Solace M6462

• Application for Non-Smoker Rate
  Use the designated form to apply for a change from a smoker rate to a non-smoker rate.

• Application Form M4672 – for Optional Life and Optional Group Critical Illness
• Application Form M4672A – for Solace plan members

• Group Life Conversion

• Group Life Conversion Privilege Notification M5725(Quebec)
  If you live in Quebec, use this form to convert group life insurance to an individual life insurance policy.
• Group Life Conversion Privilege Notification M5725
  If you live outside of Quebec, use this form to convert group life insurance to an individual life insurance policy.