Life Brokers

@pprove

Wawanesa Life’s e-business solution. We are pleased to announce that @pprove is now the exclusive platform for all your individual life business. This includes accessing client information, submitting applications, running inforce illustrations, and viewing pending business and commission details.

Go to @pprove

For technical assistance, please call 1-866-416-4722 or e-mail servicedesk@wawanesa.com.

Broker Forms

All English forms are available in fillable PDF format. You can also print them as well.

To access the fillable PDF applications, Adobe Reader is needed. Go to www.adobe.com to download the latest version for free.

Important: Please download applications and forms to your computer and complete them in the Adobe Reader program. We strongly do not recommend completing applications and forms in any web browsers as unexpected issues may occur.

Choose a section:

Change / Reinstatement / Conversion Applications

Change/Reinstatement/Conversion Application (10/2024)
Change/Reinstatement/Conversion Application (for policies issued prior to January 4, 2022)
Application for Change (Non-Medical) (07/2022)
Application for Change (Non-Medical) (for policies issued prior to January 4, 2022)
Quick Reinstatement Application (10/2024)
Amendment to Life Application or Change/Reinstatement Application (03/2014)
Disability Income Application for Reinstatement and / or Change (10/2024)

Underwriting Supplemental Forms

Voluntary Consent Form - Favourable Genetic Testing (10/2022)
Alcohol Usage Questionnaire (04/2020)
Arthritis Questionnaire (04/2020)
Attention Deficit DisorderQuestionnaire (04/2020)
Aviation Questionnaire (04/2020)
Back Pain Questionnaire (04/2020)
Backcountry Snowmobiling Questionnaire (04/2020)
Blood Pressure Questionnaire (04/2020)
Blood Pressure Recheck (04/2020)
Bronchitis or Asthma Questionnaire (04/2020)
Cancer Questionnaire (04/2020)
Chest Pain Questionnaire (04/2020)
Diabetic Questionnaire- Applicant (04/2020)
Drug Usage Questionnaire (04/2020)
Financial Questionnaire (04/2020)
Foreign Residence and Travel Questionnaire (04/2020)
Gastrointestinal Disorder Questionnaire (04/2020)
Heart Murmur Questionnaire (04/2020)
Hypertension Questionnaire (04/2020)
Motor Sports Racing Questionnaire (11/2020)
Mountaineering Questionnaire (04/2020)
Nervous Disorder Questionnaire (04/2020)
Scuba Diving Questionnaire (04/2020)
Seizure Questionnaire (04/2020)
Skydiving or Parachuting Questionnaire (04/2020)
Tobacco Usage Questionnaire (04/2020)

Annuity Applications

Guaranteed Investment Annuity (Non-Registered) Application (10/2024)
Guaranteed Retirement Annuity (RSP) Application (10/2024)
Individual Savings Plan Allocation of Contributions (10/2024)
Retirement Income Fund (RIF) Application (10/2024)
Single Premium Immediate Annuity Application (10/2024)
Registered Investment Transfer Form (10/2024)
Non-Registered Investment Transfer Form (10/2024)

Customer Service Forms

Address Change (11/2022)
Annuity Withdrawal Form (10/2024)
Agent of Record/Servicing Agent Change (05/2020)
Banking Change / Pre-Authorized Debit Application (10/2022)
Beneficiary Change (11/2022)
Collateral Assignment of Policy (05/2020)
Contingent Policy Owner Form (05/2020)
Direct Deposit Enrollment Form (06/2024)
Dividend Change (05/2020)
Name Change (11/2022)
Policy Loan Application (11/2022)
Policy Termination Request (05/2020)
Pre-Authorized Debit Agreement Cancellation Request (05/2024)
Letter of Authorization for Non-Residents (05/2020)
Request for Duplicate Policy (05/2020)
Release of Assignment (05/2020)
Transfer of Ownership (11/2022)
Declaration of Tax Residence for Individuals (2022)
Declaration of Tax Residence for Entities (2022)
Universal Life Withdrawal Form (05/2020)
Life Insurance Replacement Declaration (08/2019)

Claim Forms - Life Policies

To be completed by Claimant:

Continuing Disability - Claimant's Statement (07/2020)
Death Claim - Claimant's Statement (07/2020)
Waiver of Premium Benefit - Claimant's Statement (07/2020)

To be completed by Physician:

Continuing Disability - Attending Physician's Statement (07/2020)
Death Claim - Physician's Statement (07/2020)
Initial LTD Benefit - Attending Physician's Statement (07/2020)

Claim Forms - Critical Illness Policies

To be completed by Claimant:

All Illnesses - Claimant's Statement (06/2020)

To be completed by Physician: If the Insured’s Critical Illness is not listed here, please use the Attending Physician Statement - General Form.

Attending Physician Statement - General (06/2022)
Alzheimer's Disease - Physician's Statement (06/2020)
Benign Brain Tumor - Physician's Statement (06/2020)
Blindness - Physician's Statement (06/2020)
Cancer - Physician's Statement (06/2020)
Coronary Artery Bypass - Physician's Statement (06/2020)
Deafness - Physician's Statement (06/2020)
Heart Attack - Physician's Statement (06/2020)
Kidney Failure - Physician's Statement (06/2020)
Multiple Sclerosis - Physician's Statement (06/2020)
Organ Transplant - Physician's Statement (06/2020)
Paralysis - Physician's Statement (06/2020)
Parkinson's Disease - Physician's Statement (06/2020)
Stroke - Physician's Statement (06/2020)

Quick Needs Analysis

Quick Needs Analysis

Client Flyers

The following flyers are to be used by agents as a sales tool with their clients. All client flyers are available in electronic fillable format to allow an agent to enter their own contact information. Please note these flyers are only available for the agent to print their own copies.

Printable Format