Forms for Your Convenience

Chamber of Commerce Group Insurance Plan

Administrative Forms:

Employee Application
Employee Change Request
Employee Statement of Health and Dependants Health
Firm Benefit Change Form

Claim Forms:

Extended Health Claim Form

The Great West Life Assurance Company

Administrative Forms:

Brochure of available coverages
Employee Application
Employee Change Request
Employee Statement of Health
Pre-Authorized Payment Form
Direct Deposit Brochure and Form
GroupNet Sign-up Information for Employees

Claim Forms:

Healthcare Claim Form

Sun Life Financial

Administrative Forms:

Employee Application
Health Questionnaire
 

Claim Forms:

Extended Health Care Claim Form

The Empire Life Insurance Company

Administrative Forms:

Employee Application
Employee Statement of Health
Change/Request Form

Manulife Financial

Administrative Forms:

Employee Application
Employee Statement of Health
Health Services Navigator Application

Claims Forms:

Extended Health Care Claim Form

For all Life and Disability Claims please contact our office at 613-253-2410/1-800-507-7463