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Notice of death

Death certificate

* Fields marked with an asterisk are mandatory.

Please attach an official document : Certificate, Copy of an Act or Attestation.
If you don't have a digital version of this document or if you have mailed it or want to mail it, call us at 1 877-987-3076.

Information about the deceased

Last name *

First name *

Address

N° *

Street *

City *

Postal code *

Policy n° *

Date of birth *

About the death

Date of death *

Death *

Cause of death *

Notice received from

Last name *

First name *

Relationship to the deceased *

Contact person

Last name *

First name *

Address

N° *

Street *

City *

Postal code *

Phone N° *

Funeral home

Name

City

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