Industrial Alliance Pacific, Insurance and Financial Services


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Special Markets and Group Insurance

Forms

Special Markets Group (“SMG”) is pleased to provide our clients and customers with 24 hour access to our most frequently requested administrative and claim forms.

Simply click on the applicable link below for the form you require and the form will open in a new browser window.

Administrative Forms:

Pre-Authorized Credit Card Payment Plan Request Form (PDF - 46 KB)

Pre-Authorized Debit (PAD) Agreement (fillable) (PDF - 125 KB)

Request for Non-Smoker Rates Form (PDF - 68 KB)

Insured Name Change and/or Change of Beneficiary Form (PDF - 36 KB)

Basic Group Critical Illness Insurance Enrolment Request Form (fillable) (PDF - 434 KB)

Basic Group Critical Illness Insurance Change Request Form (fillable) (PDF - 145 KB)

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 and Information Sheet (PDF - 82 KB)

Post Secondary Student Accident Claim Form and Information Sheet (PDF - 88 KB)

Camper’s Claim Form and Information Sheet (PDF - 84 KB) (For Residents of Ontario Only)

Provincial Health:

Provincial Health Replacement Insurance Claim Form and Information Sheet (PDF - 74  KB)

Out-of Country & Province:

Out Of Country & Province Claim Form and Information Sheet (PDF - 76 KB)


(For Residents of Ontario Only)
Out Of Country & Province Claim Form & Information Sheet, including Authorization and Consent Form (PDF - 102 KB)

Student Accident Insurance (Blanket policy):

Blanket Student Accident Claim Form and Information Sheet (PDF - 195 KB)

For an IAP Kids Plus™ Accident Insurance claim form, please click here.

Please note: In providing these claim forms for the convenience of the claimant, IAP 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.

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