If you are an employer
- The Request for Conversion of group life insurance form needs to be completed no sooner than 31 days before and no later than 31 days after the employee’s termination date.
- If an employee has severance that includes the life coverage, they may apply within 31 days before and 31 days after the termination date of their group life coverage.
Completing the Request for Group Life Conversion form
You can now complete the form below on line! Make sure you clearly indicate the:
- Group policy number
- Certificate number of the Participant (employee). Tip: often this can be the date of birth or Social Insurance Number of the employee.
- Contact information – provide the home telephone number and email address. Having an email address allows us to contact the employee in a timely manner.
- Amount of coverage for Participant (employee) and their dependents
Once the form is completed, just click Send at the bottom and it is automatically submitted. You will receive a confirmation for your files if you entered your email address in the blue box at the top of the form. You can also print the pdf form and send it in via fax to
.