Site Accessibility Statement
Wilfrid Laurier University Human Resources
May 24, 2015

Canadian Excellence

Forms

Employee Benefits

Great West Life Evidence of Insurability Form


published: 21-Oct-2013 PDF (407kb) GWL_Evidence_of_Insurability_Coverage_Detail_Application_Form_Jan_2015.pdf

 
  

The Great West Life Evidence of Insurability Form can be used for the following:

  • Enrollment as a Late Applicant for health and/or dental benefits
  • Application for Optional Life insurance (please also provide Human Resources with your beneficiary information)
  • Application as a Late Applicant for Long Term Disability insurance
  • Please note that Laurier does not provide Optional Life insurance for a spouse or dependants




    updated January 28/15