1 (800) 266-5667 solutions@ia.ca
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Client Centre

Administrative Forms

Client Change Forms:

Name and Address Change
Beneficiary Designation Change
Request for Non-Smoker Rates
Request for Pre-Authorized Debit (PAD) Payment
Supplemental Questionnaire for Dependent Child Insurance
Request to Add a Child to Your Existing Plan
Termination of Coverage Request

Benefits Administrator Forms:

Basic Group Critical Illness Insurance Enrolment Request Form (Employee Only)
Basic Group Critical Illness Insurance Enrolment Request Form (Employee and Dependent Child)
Group Insurance Change Request Form
Late Application for Employee
Late Application for Spouse
Late Application for Dependent

Conversion Forms:

Critical Illness Insurance Conversion Request Form
Term Life Insurance Conversion Request Form

Claims Forms

For each claim form, we have included an information sheet that addresses the most frequently asked questions. If you are looking for a form that is not on this page, please contact our Claims Department toll-free at 1-800-266-5667 for the appropriate form and details on claims procedures.

Accident & Recreation:

Sports Accident Claim Form
Post Secondary Student Accident Claim Form
Camper’s Claim Form

Provincial Health Claims:

Provincial Health Replacement Employee Insurance Claim Form
Out Of Country & Province Claim Form
Provincial Health Alternative Student Insurance Claim Form

Blanket Student Accident Claims:

Blanket Student Accident Claim Form**For blanket student accident insurance coverage only. For Kids Plus™ Accident Insurance claims forms, please visit www.kidsplus.ca

 

Please note: In providing these claim forms for the convenience of the claimant, iA Financial Group does not admit to any liability or waive any of the terms and conditions of the policy. Provision of these claim forms does not indicate coverage. Eligible claims will be paid according to the coverage in force and the terms and conditions of the particular policy.

Can't find what you're looking for here? Contact a Client Service Representative:

1 (800) 266-5667
(Office hours: 6:30am to 4:30pm Pacific Time)

solutions@ia.ca

View and print PDF documents with Acrobat Reader.

Link to reader
 

Interested in offering our plans to your group? We'd love to hear from you.

Call 1 (800) 266-5667, or visit our contact section to find a Sales Representative near you.

 

Looking for information about your insurance plan? The client centre includes helpful information and forms.

Have a question? Our Client Service Specialists are happy to help!
Call: 1 (800) 266-5667
Email: solutions@ia.ca

 

Industrial Alliance Insurance and Financial Services Inc.
400 - 988 Broadway West
P.O. Box 5900
Vancouver, BC
V6B 5H6