By selecting, I confirm that all the information provided is accurate and in no way fraudulent. I understand and accept that all false, fraudulent or inaccurate information may result in the refusal of my claim. I authorize Humania Assurance Inc. and its agents to collect, use and disclose all personal information necessary for the adjudication of my claim concerning me or my dependent children, and for the detection and prevention of fraud.
Notice Concerning Files and Personal Information
In order to ensure the confidentiality of the personal information held concerning you, Humania Assurance Inc, will establish a file in which the information concerning your application for insurance and information concerning any insurance claim will be held. Access to this file will be restricted to Humania Assurance employees, reinsurers or mandatories who will be responsible for underwriting, administration, investigation and claims, or any other person designated or authorized by you. Your file will be kept at the Company's head office. You are entitled to examine the personal information contained in this fi le and, if required, to have the information corrected by submitting a written request to the address below: Access to Information Officer, Humania Assutrance, 1555, Girouard Street West, Postal Box 10 000, Saint-Hyacinthe (Quebec) J2S 7C8.