Obtain a form | Humania assurance

Obtain a Group Insurance Form

Plan Member

Direct deposit*

Direct Deposit - Disability

Conversion Request

Group Insurance - Conversion Application

Change of Beneficiaries or Marital Status

*For Short and Long-Term Disability insurance only. This Direct Deposit form cannot be used for medical and/or dental reimbursements.

Plan Administrator

Changes to the Group or to its Members

Notification of Change

Banking Information

Pre-Authorized Debit Agreement

Plan administrator change (to add or remove)

Plan administrator change

New enrolment

Medical or lifestyle habits questionnaires

Lifestyle Habits

Activities

Medical Conditions

To send us your documents

Three options for you

By email

adm.coll@humania.ca

By fax

450 823-0734

By mail

Humania Assurance Inc.
1555, Girouard Street West
St-Hyacinthe (Quebec) J2S 2Z6