Notice of death

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Notice of death

Please fill in the form below

Name

This field is for validation purposes and should be left unchanged.

* 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.

File(Required)

Accepted file types: jpg, gif, png, pdf, Max. file size: 1 GB.

Last name*(Required)

First name*(Required)

Address

N°*(Required)

Street*(Required)

City*(Required)

Province*(Required)

Postal code*(Required)

Phone*(Required)

Policy number*(Required)

Date of birth*(Required)

Date of death* (Required)

Death*(Required)

Cause of death*

Last name*(Required)

First name*(Required)

Relation avec le défunt*(Required)

Last name*(Required)

First name*(Required)

Address

N°*(Required)

Street*(Required)

City*(Required)

Postal code(Required)

Phone(Required)

Email*(Required)

Funeral home name

City

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