When the contract expires, the Company commits to automatically renew the contract for a period of the same length, unless you indicate otherwise. By opting for payment by credit card, your insurance coverage will not be interrupted and you will not have to send us any documents; we do it all for you! You will receive a renewal notice 30 days prior to the contract expiry date indicating the premium amount and the date upon which it will be debited from your account.
I, the undersigned, request coverage for the abovementioned person(s) under the Accifamily plan of Industrial Alliance Insurance and Financial Security Inc.
Strictly for the purposes for managing my file and settling my claims, I authorize Industrial Alliance:
To collect from any person or legal entity or from any public or parapublic organization only the information about me that is deemed necessary to manage my file. Without limitation, information may be collected from health care professionals or facilities, the Medical Information Bureau, insurance companies, personal information officers or investigation agencies, policyholders, my employer or former employers;
To communicate to said persons or organizations only the personal information about me that is deemed necessary for purposes of my file.
I also authorizes Industrial Alliance to use or supply to and exchange my personal information with its affiliates, representatives, and agents for marketing purposes.
This authorization is also valid for the collection, use and communication of personal information concerning my minor children, insofar as affected by my claim.
The coverage may be null and void if there has been a material misrepresentation by the consumer in the application process.