Forms

Pre-authorized payment form

With pre-authorized payment you don't have to write cheques to cover your group insurance plan premium payments.  Payments can be made automatically through your bank or financial institution account.

Complete and sign the Pre-authorized payment form. Return it to the Coughlin office that has been paying your claims.

You must provide either:

• a void cheque; or
• a fully encoded deposit slip from your bank from which the necessary account and coding information can be obtained.

Pre-authorized payment form