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How Canada Life is supporting you during COVID-19. Learn more

The Great-West Life Assurance Company, London Life Insurance Company and The Canada Life Assurance Company have become one company – The Canada Life Assurance Company. Learn more

The Great-West Life Assurance Company, London Life Insurance Company and The Canada Life Assurance Company have become one company – The Canada Life Assurance Company. Learn more

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Use this form to update your smoking declaration and apply to receive non-smoking rates on your Portable Life or Portable Accidental Death and Dismemberment (AD&D) insurance.

To do this, you should:

  • Download and save the correct form, Portable benefits application for non-smoker rates - M4672 (PB177914)
  • Ensure all necessary sections are filled out
  • Mail or email the completed form to Canada Life

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