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Forms

You can obtain the brochures and forms listed below by contacting Sogedent or by downloading them (some items are reserved for insureds who have user access).

Personal Group Insurance Plan brochure
You will find in this brochure answers to your questions about your Personal Group Insurance Plan, a program specifically tailored to the needs of dentists and offered only by Sogedent Assurances inc.

SSQ Financial Group Release
Changes made to the Personal Group Insurance Plan brochure effective on January 1, 2012

Application for Insurance - Prescription Drug Insurance and Complementary Health Insurance
Application form for the plan or form required to make changes to your insurance

Financial information for dentists who are members of an incorporated company
Form required to submit a request for disability income protection insurance or disability office overhead insurance for dentists who are members of an incorporated company

Financial information for not members dentists of an incorporated company
Form required to submit a request for disability income protection insurance or disability office overhead insurance for not members dentists of an incorporated company

Evidence of Insurability
Medical questionnaire for you, your spouse and children, sent to the insurer for approval of your insurance application

Declaration of Spouse and Dependent Children
Using this form, you tell us who are your spouse and dependent children

Confirmation of Student Status
Using this form, you tell us who are your dependent children, aged 21 to 25, who are studying full-time

Questionnaire on Tobacco Use
You must fill out this form when you are asked to describe your smoking habits.

Change of Beneficiary
This form allows you to change the beneficiary under your insurance policy.

Request for Conversion - Group Life Insurance
Form used to change the portion of the insured amount that is deducted from the individual life insurance group plan without proof of good health (the request must be received within 31 days following the expiration or the reduction of the amounts covered under the group life insurance)

Claim Form - Life Insurance
Form required to submit a claim to the insurer

Disability Claim Form - Initial Request
Form required to submit a disability claim to the insurer

Request for Reimbursement - Office Overhead
Form required to submit a claim to the insurer

Claim Form – Medical Expenses
Form required to submit a claim to the insurer

Request for reimbursement - Loss of income
Form required to submit a request for reimbursement - Loss of income

Direct Deposit of Benefits
Form used to request that the insurer deposit your claims directly into your bank account

Pre-Authorized Debit Agreement
Form used to authorize us to deduct your premiums directly from your bank account

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