-

Minimize
UNDERWRITING SECTION

Welcome to the underwriting section.  If you need help, our underwriting team is here for you! You can contact them at 1 800 455-7337 or via email at the following address:underwriting@assumption.ca.

 

 

 

UNDERWRITING MEDICAL QUESTIONNAIRES
NUMBER 
TITLE
DATE          
4413-00A Arthritis, Rheumatism or Gout Questionnaire                                        AUG2017
4473-00A Authorization of Proposed Insured (1) and (2)                                                    AUG2013
3881-00A Back Pain Questionnaire AUG2017
3884-00A Chest Pain Questionnaire AUG2017
3888-00A Convulsion Questionnaire AUG2017
3886-00A Diabetes Questionnaire AUG2017
3894-00A Gastro-Intestinal Questionnaire AUG2017
3896-00A Heart Examination Questionnaire (Attending Physician) AUG2017
3900-00A Psychological or Nervous Disorder Questionnaire AUG2017
3907-00A Respiratory Disorder Questionnaire AUG2017
Diabetes Questionnaire (to be completed by attending physician)
AUG2017
Musculoskeletal Disorder Questionnaire
AUG2017
Authorization to Disclose Personal Information SEP2015
 

UNDERWRITING SPORTS & LIFESTYLE QUESTIONNAIRES
NUMBER
TITLE
DATE
3876-00A Alcohol Use Questionnaire                                                                                  AUG2017
3880-00A Aviation Questionnaire                                                    AUG2017
3887-00A Drug and Substance Usage Questionnaire APR2019
3890-00A Financial Questionnaire AUG2017
3893-00A
Foreign Travel & Residence Questionnaire
AUG2017
3908-01A
Scuba Diving Questionnaire
AUG2017
3910-00A Tobacco Usage Questionnaire
AUG2017
3970-00A Disability Insurance Questionnaire AUG2017
4885-00A Hazardous Sports and Activities Questionnaire AUG2017
4018-00A Driving Record Questionnaire AUG2017
5225-00A Questionnaire for individuals without permanent status in Canada JAN2019
5337-00A Criminal Activity Questionnaire
AUG2017
 
Login