Forms

Applications

• Privileged Selection group life insurance application
• Privileged Selection critical illness insurance application

Individual financial services applications

• Individual health and dental coverage application (For all provinces except Quebec)
• Benefits beyond age 65 application (For all provinces except Quebec)
• Individual health and dental coverage application (Quebec only)
• Benefits beyond age 65 application (Quebec only)

Just complete, sign and return the application to:

Individual Financial Services
Coughlin & Associates Ltd.
PO Box 3517, Station C
Ottawa, ON   K1Y 4H5

Or, contact Coughlin & Associates Ltd. at 613-231-2266, ext 251 or toll-free 1-888-613-1234, ext 251.