Industrial Alliance Pacific, Insurance and Financial Services


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Special Markets and Group Insurance

Forms

Special Markets Group (“SMG”) is pleased to provide our clients and customers with 24 hour access to our most frequently requested administrative and claim forms.

Simply click on the applicable link below for the form you require and the form will open in a new browser window.

Administrative Forms:

Pre-Authorized Payment Plan Request Form (PDF - 54 KB)

Request for Non-Smoker Rates Form (PDF - 68 KB)

Insured Name Change and/or Change of Beneficiary Form (PDF - 36 KB)

Claims Forms:
 
For each claim form, we have included an information sheet that addresses the most frequently asked questions.

If you are looking for a form that is not on this page, please contact our Claims Department toll-free at
1-800-266-5667 for the appropriate form and details on claims procedures.

Accident & Recreation:

Sports Accident Claim Form and Information Sheet (PDF - 175 KB)

Post Secondary Student Accident Claim Form and Information Sheet (PDF - 177 KB)

Camper’s Claim Form and Information Sheet (PDF - 179 KB) (For Residents of Ontario Only)

Provincial Health:

Provincial Health Replacement Insurance Claim Form and Information Sheet (PDF - 176 KB)

Out-of Country & Province:

Out Of Country & Province Claim Form and Information Sheet (PDF - 182 KB)


(For Residents of Ontario Only)
Out Of Country & Province Claim Form & Information Sheet, including Authorization and Consent Form (PDF - 281 KB)

Student Accident Insurance (Blanket policy):

Blanket Student Accident Claim Form and Information Sheet (PDF - 76 KB)

For an IAP Kids Plus™ Accident Insurance claim form, please click here.

Please note: In providing these claim forms for the convenience of the claimant, IAP does not admit to any liability or waive any of the terms and conditions of the policy. Provision of these claim forms does not indicate coverage. Eligible claims will be paid according to the coverage in force and the terms and conditions of the particular policy.

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