Enrollment Forms

It is necessary for all applicants enroling in the Fellowship Group Insurance Plan to complete the following forms and return them to the office for processing. Downloads of the various forms can be found at the end of each form description.

  • Fellowship Healthcare Coverage

    Fellowship Healthcare Coverage
    Download
    (206KB)

  • Pre-Authorized Chequing form

    To download a copy of the Pre-Authorized Chequing form, click the link below.
    Download
    (305KB)

  • Evidence of Insurability Coverage Detail form

    To download a copy of the Evidence of Insurability Coverage Detail form, click the link below.
    Download
    (3159KB)

  • CHUBB Beneficiary Form

    CHUBB Beneficiary Form
    Download
    (156KB)

  • Supplementary Unemployment Benefit Plan form

    To download a copy of the Supplementary Unemployment Benefit Plan Response form, click the link below.
    Download
    (168KB)

  • Social Insurance Authorization form

    To download a copy of the Social Insurance Authorization form, click the link below.
    Download
    (67KB)

  • Long-Term Disability Salary Calculation

    To download a copy of the Group Benefits Long-Term Disability Salary Calculation sheet, click the link below.
    Download
    (78KB)

  • Group Benefits Insurance Plan Info. Fact Sheet

    To download a copy of the Group Benefits Insurance Plan Information Fact Sheet, click the link below.
    Download
    (69KB)

  • Voluntary Accident Insurance Application form

    To download a copy of the Voluntary Accident Insurance Application form, click the link below.
    Download
    (87KB)

  • Application for Group Coverage form

    To download a copy of the Application for Group Coverage form, click the link below.
    Download
    (105KB)

  • Beneficiary Designation Form

    To download a copy of the Beneficiary Designation form, click the link below.
    Download
    (63KB)