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1.
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Open and Print the Group Application Form PDF file (PDF - 147 KB)
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2.
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Complete in full
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3.
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Mail your completed application, along with payment information to IAP’s office.
Please note you will need Adobe Acrobat Reader, available for free from Adobe, to view and print the application form. |
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How Much Will This Coverage Cost Each Month & How Can I Pay? |
With the comfort and security provided by this coverage the cost per month is minimal. Depending upon which coverage plan and amount best suits your needs your monthly premium can vary. Follow the chart below to determine your monthly payment amount.
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Accidental Death Insurance
Monthly Premium Rates |
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$25,000 |
$50,000 |
$100,000 |
Customer Only Plan |
$2.95 |
$5.90 |
$11.80 |
Customer & Spouse Plan |
$4.43 |
$8.85 |
$17.70 |
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Monthly premiums can be paid by credit card or pre-authorized cheque.
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Who Do I Contact if I Have a Question About the Application Form or Coverage? |
If you have a question about the application form, product or coverage feel free to contact Industrial Alliance
Pacific Insurance and Financial Services Inc., Special Markets Group toll-free at 1-800-266-5667 (7:30 am to 5:30 pm MST Monday-Friday) where a representative can assist you. Inquiries can also be emailed to group@iapacific.com.
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Where Should I Send My Application Form? |
Please mail your completed application form and payment information to:
Industrial Alliance
Pacific Insurance and Financial Services Inc.
SMG Prairie Regional Office
#2050 – 777 8th Avenue S.W.
Calgary, AB
T2P 3R5
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What Happens Once I Apply? |
Once your application is received and processed, a Certificate of Insurance and Insurance Benefits Summary will be sent to you for your 30-day review and acceptance.
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