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Claims

Creditor Life Claims Forms

Please remember:
 
  • Any fees incurred for the completion of the forms are your responsibility. Please discuss the fee with your physician
Where to send your claim information:
 
Claims Centre
CUMIS Life Insurance Company
P.O. Box 5065
151 North Service Road
Burlington, ON L7R 4C2
 
 
Toll free phone number: 1-800-263-9120
Toll free confidential claims fax number: 1-800-897-7065

Life Claim Forms - Credit Card Balance Protection, Mortgage Protection, Loan and Line of Credit Protection

English

Notice of Death – Creditor Insurance CR101

Proof of Death - Physician's Statement CR116

Disclosure Authorization – Death Claim CR111

Français

Avis de Décès – Assurance Crédit CR101F

Preuve de Décès - Déclaration du Médecin CR116F

Autorisation de Divulgation de Renseignements – Demande de Règlement en cas de Décès CR111F

Life Claim Forms - Member Term Life

English

Notice of Death – Member Term Life CR103

Proof of Death - Physician's Statement CR116

Disclosure Authorization – Death Claim CR111

Français

Avis de Décès – Assurance-Vie Temporaire des Membres CR103F

Preuve de Décès - Déclaration du Médecin CR116F

Autorisation de Divulgation de Renseignements – Demande de Règlement en cas de Décès CR111F​

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