Insurance Forms

Extended Health Care

Application for Extended Health Benefit

Claim form for Extended Health Care Benefits

Office Overhead Expense Insurance

Application for Office Overhead Expense Insurance and Disability Income

Disability Income

Application for Office Overhead Expense Insurance and Disability Income

Future Insurance Option Application to Exercise FIO1

Future Insurance Option Application to Exercise FIO2

Medical Requirements Checklist

Accident Insurance

Accident Insurance Application

Life Insurance

Application for Life Insurance

Application to Exercise Future Insurance Option

Life Insurance Assignment Form

Life Insurance Change Form

Life Insurance Non-Smoker Declaration

Pre-Authorized Payments

Pre-Authorized Payment Application Form

PARIM Insurance

PARIM Endorsement of the Doctors Manitoba Insurance Program

Doctors Manitoba/CMA/PARIM/RDoC Membership Application

Application for PARIM Group Insurance