Industrielle Alliance, Insurance and Financial Services


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Life Insurance

Mortgage Insurance

Critical Illness
      Insurance

Disability Insurance

Insurance Without
      Medical Examination

Accident Insurance for
      the Entire Family

Accident Insurance
      for Newborns

Critical Illness
      Insurance for Children

Claim Forms

Calculators

To File a Complaint




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Life and Health Insurance

Claim Forms

We are pleased to provide online access to our claim forms. Click on the link related to the form you need. The form will open in a new browser window. You will then be able to print it.


        
Death
Death - Claimant's Statement (F55-21A) For all claims following the death, for policies that have been in force for less than ten years or for which the insurance amounts are higher than $50,000
Death - Claimant's Statement - Simplified Version (F55-21A(2)) For all claims following the death for policies that have been in force for at least ten years without interruption and for which the insurance amounts are $50,000 or less
Proof of Death-Attending Physician's Statement (F55-22A) For all claims following a death and meeting the following criteria:
  • Policy $100,000 or more if issued or reinstated in the last 10 years
  • Policy $50,000 or more if issued or reinstated in the last 5 years
  • Policy issued or reinstated in the last 3 years for any amount
Critical Illness
Critical Illness (F37-20A) For all claims under a critical illness coverage
Disability
Disability - Claimant's Statement (F35-55A) For all claims under a disability coverage
Accidental Fracture
Accidental Fracture - Claimant's Statement (F37-18A) For all claims under an accidental fracture coverage for your life insurance policy
Accident Insurance
Accifamily (F13-175A) For all claims under an Accifamily accident insurance held personally
Accigroup (F13-175A(1)) For all claims under an Accigroup or Accigroup Plus accident insurance provided through an organization

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