If you have coverage through your employer or plan sponsor, use our workplace benefits insurance forms. If you have coverage through an advisor, use our personal insurance forms.  

Use this form to make a claim for accidental death, dismemberment or specific loss.

To make a claim:

Download this form and print it, or fill it out in Adobe Reader XI or higher (not your browser) and save.

Download this form and print it, or fill it out in Adobe Reader XI or higher (not your browser) and save.

When both parts are completed, please send a scanned copy to us via email at grouplifebenefits@canadalife.com or by fax at (204) 946-8783.

In light of COVID-19, we ask that you do not mail these forms to us.