Application for insurance - Canadian Dental Hygienists Association 2025

1. Click ‘Get Form’ to open the Application for insurance in the editor.
2. Begin by filling out the General Information section. Clearly print your name, date of birth, and contact details including telephone and email address. Ensure you indicate your gender and smoking status.
3. In the Coverage Applied For section, select the desired coverage options such as Basic Life and Accidental Death. Provide your beneficiary's details, ensuring to check either Revocable or Irrevocable designation.
4. For Premium Payments, enter the account holder's name and financial institution details. Make sure to read and agree to the Pre-Authorized Debit (PAD) terms before signing.
5. Complete the Declaration and Authorization section by confirming that all information is accurate. Sign and date where indicated.

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