Claims Forms

Our claims forms are available below in PDF format. These are editable forms that can be filled out and e-mailed to us, or printed out and faxed/mailed to us.

Note: All claims forms submitted via e-mail require a signature, forms can be submitted to This e-mail address is being protected from spam bots, you need JavaScript enabled to view it .

• Dental Claim - English
• Dental Claim - French
• Vision Claim - English
• Vision Claim - French
• Extended Health Claim - English
• Extended Health Claim - French

• Application Form
• Merchant Agreement
• Electronic Funds Transfer
• Pre-Authorized Payment
• Education Status Update

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