Here you'll find the forms to fill out for the different services we offer so we can serve you quickly and efficiently, whatever your situation. Tell us what you need, and we’ll take care of the rest!
Frequently viewed
Auto and home insurance
Claims
- File a claim
- Track a claim
- Request a roadside assistance reimbursement
- (This coverage must be included in your contract)
For all other requests, please contact customer service by completing this form.
Individual insurance
Extended medical care
- Claim form accident, health insurance benefit (PDF 157.47 kB)
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For all claims made under complementary medical/dental care coverage.
- Exceptional drug authorization request (PDF 131.97 kB)
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For all claims made under complementary medical/dental care coverage.
Group insurance
Prescription drugs
- List of drugs requiring prior authorization (PDF 181 ko)
- Brochure – Drugs requiring prior authorization (PDF 286 ko)
- Request for prior authorization – Drugs (PDF 229 ko)
- Request for prior authorization – OZEMPIC and RYBELSUS (PDF 107 ko)
- Request for prior authorization – FreeStyle Libre sensor (PDF 257 ko)
- Request for brand name drug exception (PDF 85 ko)
- Request for reference biologic drug exception (PDF 109 ko)
Health, dental care and disability
Administrative forms
- Enrolment request (PDF 261 ko)
- Enrolment request – with online beneficiary designation (PDF 441 ko)
- Change request (PDF 303 ko)
- Change request – with online beneficiary designation (PDF 306 ko)
- Evidence of insurability (PDF 655 ko)
- Appointment or change of beneficiary (PDF 82 ko)
- Overage dependent with a disability (PDF 93 ko)
- Modification of status from smoker to non-smoker (PDF 128 ko)
Specialized products – Creditor insurance
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Creditor insurance for investment funds (Contract 70011)
- Distribution guide – Contract 70011 (PDF 179 ko)
- Certificate of insurance – Contract 70011 (PDF 954 ko)
- Summary of insurance – Contract 70011 (PDF 434 ko)
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Loan insurance (line of credit, mortgage loan and personal loan) – Laurentian Bank
- Certificate of insurance – Line of credit, mortgage loan and personal loan (PDF 836 ko)
- Summary of insurance – Line of credit (PDF 803 ko)
- Summary of insurance – Mortgage loan (PDF 787 ko)
- Summary of insurance – Personal loan (PDF 824 ko)
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Travel insurance – Laurentian Bank Visa
- Certificate of insurance – Travel (PDF 1.7 mo)
- Summary of insurance – Travel (PDF 783 ko)
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Purchase insurance and extended warranty – Laurentian Bank Visa
- Certificate of insurance – Purchase and extended warranty (PDF 1.9 mo)
- Summary of insurance – Purchase and extended warranty (PDF 752 ko)
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Assur-payment – Laurentian Bank Visa
- Certificate of insurance – Assur-payment (PDF 202 ko)
- Summary of insurance – Assur-payment (PDF 784 ko)
Savings and retirement
Special markets
Claim forms
Please contact our Claims Department toll-free at 1 800 266‑5667 for the appropriate form and details on claims procedures.
Client change forms
- Request for Pre-Authorized Debit (PAD) Payment (PDF 210.68 kB)
- Request to Add a Child to Your Existing Plan (PDF 93 kB)
- Termination of Coverage Request (PDF 195 kB)
- Supplemental Questionnaire for Dependent Child Insurance (PDF 121.31 kB)
- Name and Address Change (PDF 81.05 kB)
- Request for Non-Smoker Rates (PDF 273.48 kB)
- Beneficiary Designation Change (PDF 113.51 kB)
Forms for administrators of a group plan
- Basic Group Critical Illness Insurance Enrolment Request Form (Employee and Dependent Child) (PDF 141.13 kB)
- Group Insurance Change Request Form (PDF 90.03 kB)
- Basic Group Critical Illness Insurance Enrolment Request Form (Employee Only) (PDF 64.01 kB)
- Late Application for Spouse (PDF 273.47 kB)
- Late Application for Dependent Child (PDF 171.33 kB)
- Late Application for Employee (PDF 185.57 kB)