Optional coverage forms
Are you a plan administrator?
Use these forms to enrol plan members in optional AD&D, critical illness insurance, or life insurance. You'll find instructions on how to return the completed form on the form itself.
Download a form
Download the form and print it, or fill it out in Adobe Reader XI or higher (not your browser) and save.
Plan members use this form to apply for optional group AD&D coverage. The plan sponsor must fill out Section 1.
Use this form to prove a plan member’s insurability for optional critical illness or life insurance.
Use this form to prove a member’s insurability for critical illness or life insurance under a SelectPac plan.