Individual Insurance
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Individual Insurance - Forms
Death
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Claimants Statement Death Claim (for life insurance issued less than 10 years ago or for a value of over $200,000)
(PDF [147.62 KB]) -
Claimants Statement Death Claim (for life insurance issued more than 10 years ago and valued at less than $200,000)
(PDF [146.13 KB]) -
Death certificate (Attending Physician)
(PDF [187.61 KB])
Disability
Critical illness
Accident
Loss of employment
Modification of name, address, owner or beneficiary
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Modification (name - address)
(PDF [137.86 KB]) -
Beneficiary Replacement
(PDF [143.17 KB]) -
Change / Designation of Contingent Beneficiary
(PDF [92.30 KB]) -
Policy Owner Replacement
(PDF [174.74 KB]) -
Contingent Owner Designation
(PDF [139.53 KB]) -
Certified Copy - Resolution of the Board of Directors
(PDF [121.16 KB])
Cancellation, cash value, loan, paid-up and dividends request
Various changes and requests
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Conversion exchange form
(PDF [164.20 KB]) -
Request for Fund Transfer / Additional Lump Sum Deposit (Ulysse)
(PDF [348.41 KB]) -
Life Insurance Application (child rider)
(PDF [140.85 KB]) -
Addition to the application (Credit Insurance rider)
(PDF [221.86 KB]) -
Request for Financial Advisor Replacement (Interactive PDF)
(PDF [149.77 KB]) -
Request for Policy Duplicate
(PDF [95.58 KB]) -
Modification Form
(PDF [107.86 KB]) -
Assignment - Guarantee
(PDF [133.89 KB]) -
Pre-authorized Bank Withdrawal (PAW)
(PDF [179.09 KB]) -
Retrocession
(PDF [145.87 KB]) -
Authorization letter non-resident
(PDF [107.10 KB]) -
Request for Policy Certificate
(PDF [132.10 KB]) -
Policyholder(s)/Payor(s) Identity Verification
(PDF [168.73 KB])
Application
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Application | Individual Insurance
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Eligibility Questionnaire 1 – Simplified Issue | Term and Permanent Life Insurance
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Eligibility Questionnaire 2 - Credit Insurance Rider
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Eligibility Questionnaire 3 - Additional Coverages
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Eligibility Questionnaire 4 - Simplified Issue | Children from 15 days to 15 years old
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Application | Early Learning
Life habits
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Alcohol Questionnaire
(PDF [166.09 KB]) -
Drug Questionnaire
(PDF [168.00 KB]) -
Tobacco Questionnaire
(PDF [138.27 KB]) -
Mountain Climbing Questionnaire
(PDF [101.00 KB]) -
Parachute and Free Jump Questionnaire
(PDF [93.22 KB]) -
Scubadiving Questionnaire
(PDF [100.96 KB]) -
Driving Questionnaire
(PDF [99.27 KB]) -
Car Racing Questionnaire
(PDF [101.02 KB]) -
Motorcycling Questionnaire
(PDF [100.76 KB]) -
Foreign Travelling Questionnaire
(PDF [93.38 KB]) -
Aviation Questionnaire
(PDF [99.31 KB]) -
Financial Questionnaire
(PDF [98.55 KB]) -
Military Questionnaire
(PDF [99.19 KB]) -
Hot-Air Balloon, Hang Glider and Ultralight Questionnaire
(PDF [100.72 KB]) -
Questionnaire for Motor Boat Racing
(PDF [96.92 KB]) -
Questionnaire for Mining Workers
(PDF [92.81 KB]) -
Authorization for the Disclosure of a Driving Record by the SAAQ
(PDF [65.45 KB])
Health
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Complementary questionnaire to the Individual Insurance Application (Credit Insurance Rider)
(PDF [221.86 KB]) -
Medical Disorder Questionnaire
(PDF [98.08 KB]) -
Headache Questionnaire
(PDF [95.83 KB]) -
Questionnaire for Mental Illness or Emotional Disorders
(PDF [99.85 KB]) -
Gastrointestinal Disorder Questionnaire
(PDF [94.51 KB]) -
Rhumatism, Arthritis or Gout Questionnaire
(PDF [96.49 KB]) -
Hypertension Questionnaire
(PDF [98.32 KB]) -
Questionnaire on Epilepsy, Convulsions and Loss of Conscience
(PDF [96.07 KB]) -
Diabetes Questionnaire
(PDF [94.46 KB]) -
Back Pain Questionnaire
(PDF [96.97 KB]) -
Respiratory Disorder Questionnaire
(PDF [98.08 KB]) -
Musculoskeletal Disorder Questionnaire
(PDF [97.90 KB]) -
Questionnaire regarding AdapCI-Hybrid Option
(PDF [164.29 KB]) -
Attention deficit disorder with or without hyperactivity Questionnaire
(PDF [142.39 KB]) -
Insurability declaration at policy delivery
(PDF [521.22 KB]) -
Declaration of insurability
(PDF [489.40 KB]) -
Insurability declaration for life (insurance children rider T25)
(PDF [535.61 KB]) -
Insurability Declaration at Policy Delivery - Child (0-15 years)
(PDF [299.05 KB]) -
Formulaire d'analyse des besoins (complet) (French only)
(PDF [706.49 KB]) -
Formulaire d'analyse des besoins (abrégé) (French only)
(PDF [215.10 KB])
Application
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Application | Individual Insurance (Interactive PDF)
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Eligibility Questionnaire 1 – Simplified Issue | Term and Permanent Life Insurance
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Eligibility Questionnaire 2 - Simplified Issue | Credit Insurance Rider
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Eligibility Questionnaire 3 - Simplified Issue | Additional Coverages
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Eligibility Questionnaire 4 - Simplified Issue | Children from 15 days to 15 years old
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Application | Early Learning (Interactive PDF)
Marketing Documents
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Type of Issue
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Summary of Products for Adults
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Summary of Products for Children
(PDF [205.47 KB]) -
Summary of Additional Protections
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Early Learning
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Confirmation of contract delivery Early Learning Program
(PDF [362.67 KB]) -
Juvenile 30/100
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Adaptable
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Integral
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Term Life Insurance
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AdapCI and AdapCI Juvenile
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Contact List for partners
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Teladoc | AdapCI
(PDF [513.66 KB])
Tools and Resources
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Credit Insurance Rider (Practical Guide)
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What set us appart
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Our history
(PDF [1.99 MB]) -
UV Insurance at a glance
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Underwriting Requirements
(PDF [72.56 KB]) -
Autorization form
(PDF [79.78 KB]) -
Underwriting Guide
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Credit Insurance Rider (Needs calculator)
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Analyse des besoins | ABC de vos besoins financiers (Abrégé) (French only)
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Analyse des besoins | ABC de vos besoins financiers (Complet) (French only)
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Ulysse 2000 (universal life)
(PDF [348.41 KB]) -
Consent form | Contact by email
(DOCX [56.85 KB])