Online change form

Online change form

Policy Service Application

If the policy is assigned or there is a bankruptcy on the policy, complete and submit the fillable Policy Service Application.

If the owner has more than one policy and the change request is for both policies, complete a seperate online form for the 2nd policy.

To request a Policy Split or Serverance, complete and submit the fillable Policy Service Application.

Is the policy individual or corporate owned: *
Individual Corporation

Selection is required.

Policy Owner's first name: *

The Policy Owner's first name is required.

Policy Owner's last name: *

The Policy Owner's last name is required.

Corporation name: *

Corporation name is required.

Policy number: *

Policy number is required.

Email address: *

Email is required. Invalid email address.

Cell phone number: *

Cell phone number is required. Invalid phone number.

A passcode will be sent to your cell phone after your successful submission. Please enter the code on the next page.

ivari P.O. Box 4241, Station A Toronto ON M5W 5R3

Questions? Call 1-800-846-5970 (Mon to Fri, 8:00 a.m. – 7:00 p.m. ET)